Student Registration Student's Name* First Last Date of Birth* Month Day Year Cell Phone*Email* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code School Currently Attending* Grade*6th7th8th9th10th11th12thParent/Guardian #1* First Last Parent/Guardian #1 Home Phone*Parent/Guardian #1 Cell Phone*Parent/Guardian #1 Email* Parent/Guardian #1 Address* Same as Student's address Different from Student's address Parent/Guardian #1 Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent/Guardian #2 (optional) First Last Parent/Guardian #2 Home PhoneParent/Guardian #2 Cell PhoneParent/Guardian #2 Email Parent/Guardian #2 Address Same as Student's address Different from Student's address Parent/Guardian #2 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Δ
