Student Hill Day Registration
Student Information
A registration form must be completed for each student attending Florida PTA Student Hill Day. Students under the age of 18 must be accompanied by an adult chaperone or parent who is at least 21 years old. The accompanying adult is responsible for the student’s supervision, transportation, and conduct throughout the event. Chaperone or parent information must be included on the student’s registration form.
Student Name
*
First Name
Middle Name
Last Name
Suffix
School Name
*
County
*
Please Select
Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
DeSoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden
Gilchrist
Glades
Gulf
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lafayette
Lake
Lee
Leon
Levy
Liberty
Madison
Manatee
Marion
Martin
Miami-Dade
Monroe
Nassau
Okaloosa
Okeechobee
Orange
Osceola
Palm Beach
Pasco
Pinellas
Student Email
*
example@example.com
Student Phone Number
*
Format: (000) 000-0000.
Is the student a PTA/PTSA member?
*
Please Select
Yes
No
Name Student of PTA/PTSA Local Unit
*
Student Grade
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
College
Chaperone/Parent Information
Each student under the age of 18 must be accompanied by a parent or designated chaperone who is at least 21 years old. Chaperones are responsible for the student’s supervision, transportation, and behavior during all portions of Florida PTA Student Hill Day. A separate registration form must be submitted for each student, and the accompanying chaperone’s information must be provided in full to confirm participation.
Chaperone/Parent Name
*
First Name
Middle Name
Last Name
Suffix
Chaperone/Parent Phone Number
*
Format: (000) 000-0000.
Chaperone/Parent Email
*
example@example.com
Is chaperone/parent a PTA/PTSA member?
*
Please Select
Yes
No
Name Chaperone/Parent of PTA/PTSA Local Unit
*
Submit
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