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Student Information (Required)

Student Name*

First Last

School*

Grade Level*

Student Email Address (please list an email you check frequently)*

Enter Email Confirm Email

Student Phone Number*

Student Mailing Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 1*

First Last

Relationship to Student*

Parent/Guardian 1 Phone Number*

Can we text you about upcoming events/important information?*

Parent/Guardian 1 Email Address (please list an email you check frequently)*

Enter Email Confirm Email

Parent/Guardian 2

First Last

Relationship to Student

Parent/Guardian 2 Phone Number

Can we text you about upcoming events/important information?

Parent/Guardian 2 Email Address (please list an email you check frequently)

Enter Email Confirm Email

Signature*

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Date*