School Year Registration

The following form must be completed to register. Required fields are marked with an *

General

District*

Account ID

Guardian 1

First Name*

Last Name*

Relationship*

Address*

City*

State* Zip*

Home Phone*

Office Cell

Business Name*

Business Address*

Email*

Guardian 2

First Name

Last Name

Relationship

Address

City

State Zip

Home Phone

Office Cell

Business Name

Business Address

Emergency Contact (not a guardian)

Name*

Address*

Relationship

Phone (when child in care)*

Child 1

First Child's Name*

Lives With

Birthdate*

Grade in Fall*

Gender*

School in Fall*

Teacher (if known)

AM Bus Number (if known)

PM Bus Number (if known)

Start Date*

Medical Information or Special Needs

Child 2

Second Child's Name

Lives With

Birthdate

Grade in Fall

Gender*

School in Fall

Teacher (if known)

AM Bus Number (if known)

PM Bus Number (if known)

Start Date

Medical Information or Special Needs

Medical Information

Child's Physician Name*

Address*

Phone*

Health Insurance name*

Policy Number*