Student Registration

Parent First Name *

Parent Last Name *

Email *

Address *

City/Town *

Zip Code/ Postal Code *

State/Province * Select one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Home Phone Number *

Cell Phone Number *

Emergency Contact Name *

Emergency Contact Number *

Will need rides to school? *

Yes

No

Will need rides from school? *

Yes

No

Bus Stop Address

Student Last Name (1) *

Student First Name (1) *

School Name *

Grade Level *

Date of Birth *

Comments

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