360 College for Me Registration

1. Registration Deadline: Monday, March 17, 2014

Important: Registration is not complete without signed waiver. You can pick up a waiver at your school.

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* Student Name:

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* Parent/Guardian Name:

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* Address:

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* City:

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* State:

MN

WI

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* Zip Code:

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* Phone Number:

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* Parent/Guardian E-Mail:

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* School Name:

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* Grade:

6

7

8

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* Emergency Contact Information:

Emergency Contact Name:

Emergency Contact Phone Number:

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* Please list all special dietary needs for the student. (Optional)