Ragamala School Registration Form 2018

Contact Information

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* 1. Student name

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* 2. Parent #1 name (if student is under 18)

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* 3. Parent #2 name (if student is under 18)

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* 4. Address

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 5. Parent #1 (or Student if over 18) email and cell phone

Email Address

Phone Number

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* 6. Parent #2 email and cell phone

Email Address

Phone Number

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* 7. Student email and cell phone

Email Address

Phone Number

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* 8. Emergency Contact

Name

Phone Number

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* 9. For new students – how did you hear about Ragamala? Why did you choose to enroll in our school?

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20% of survey complete.