First Name *

Last Name *

Gender

Date of Birth *

Phone Number *

ALLERGIES/ HEALTH CONDITIONS

Preferred Method of Contact *

Parents First Name and Last Name *

Mobile Number *

Email Address *

I GIVE PERMISSION FOR MY CHILD TO BE CONTACTED BY LEADERSHIP VIA TEXT/SOCIAL MEDIA YES TO TEXT AND SOCIAL MEDIAYES TO TEXTYES TO SOCIAL MEDIANO TO BOTH

Location *

ADDITIONAL INFORMATION ABOUT STUDENT