School Information

Family Name

First Name

Does your child have any medical conditions?

Yes
No

If "yes" please give additional information

Does your child have any allergies?

Yes
No

If "yes", please give the source of allergy, i.e. peanut, bees, etc.

Does your child require an Epi-Pen?

Yes
No

Name of Emergency contact:

Phone Number

User Agreement

I hereby approve that my son/daughter attend this orientation program.

Parent/Guardian Name

Parent Email