Welcome to Shadow Registration 2015-16 Question Title * 1. Welcome to Shadow Day Registration!On what DATE is your 5th grader scheduled to shadow at Roland Park Elementary/Middle School (RPEMS)? Question Title * 2. What is your 5th grade student's name? Name: Question Title * 3. Where does your 5th grader/prospective middle school student currently attend school? Question Title * 4. In what program is he/she shadowing? The citywide Advanced Academic Program The Ingenuity Program The RPEMS General Education Program Question Title * 5. Would you please tell us a little about yourself? Name: Relationship to Student: Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 6. How did you hear about RPEMS? Question Title * 7. Are there any safety, medical or other needs we should be aware of in order to make your student’s shadow experience at RPEMS great? Question Title * 8. In case of emergency, whom should we call first? Name: Phone Number: Name: Telephone Number: Relationship to Student: Question Title * 9. If your primary emergency contact is not available, whom should we call? Name: Telephone Number: Relationship to Student: Question Title * 10. Who will be picking up the student?Please remember to bring a valid government-issued ID such as a drivers license, state ID, US passport or military ID. Name: Relationship to the Student: Next