NEW STUDENT FORM Student Information Student name * First Name Last Name Student Pronouns Student Birthday * MM DD YYYY Current Age & Grade Student School Workshop name & date * Parent / Guardian Information Your name * First Name Last Name Your relation to child * Your email * Your phone number * (###) ### #### Your address * Second adult contact name * First Name Last Name Second adult contact relation to child * Second adult phone number * (###) ### #### Please list any additional adults authorized for drop-off and pick-up Accommodation Information Does your child have any food allergies, medical conditions, behavioral issues or special caretaking needs for us to be aware of? * yes no If yes, please include preferred course of action in the event something happens, including any specific doctors names and contact info. Name of Doctor First Name Last Name Contact information Thank you! We look forward to seeing you for class.
