Student Information

Child's First name*

Child's Last name*

Grade*

Allergies / Medical Info:*

Parent / Guardian #1 - contact info

Parent/Guardian #1 - Full Name *

Cell Phone #1*

Email #1*

Parent/Guardian #2 - Full Name *

Cell Phone #2*

Email #2*

Please list additional Emergency Contacts (not parents/guardians)

Emergency Contact #1 - Full Name*

Emergency Contact #1 - Cell Phone*

Authorized to pick up

Emergency Contact #2 - Full Name*

Emergency Contact #2 - Cell Phone*

Authorized to pick up

Anything else we should know?

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