Monday, February 6, 2012

Middle School LIVE Time Registration

Name of Student*
FirstLast
First child to be registered
Date of birth*
MM
DD
YYYY
Age*
Current Grade *
Name of Middle School
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Home Phone
Format (###) ###-####
Parent/Guardian 1 Name*
FirstLast
Parent/Guardian 1 Cell Phone
Format (###) ###-####
Parent/Guardian 1 Email
Parent/Guardian 2 Name
FirstLast
Parent/Guardian 2 Cell Phone
Format (###) ###-####
Parent/Guardian 2 Email
Emergency Contact Name*
FirstLast
Emergency Contact Phone*
Format (###) ###-####
Relationship to Student*
Special needs/allergies/medications
Include information for all children who will be registered
Name (second child)
FirstLast
Date of birth (second child)
MM
DD
YYYY
Age (second child)
Current Grade (second child)
Name of Middle School (second child)
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