Opening Week Enrollment Registration

PARENT INFORMATION

Question Title

* 1. Parent/Guardian #1 Information

First Name

Last Name

Work Phone

Cell Phone

Email Address

Home Address

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* 2. Parent/Guardian #2

First Name

Last Name

Work Phone

Cell Phone

Email Address

Home Address

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* 3. Are you an EA Faculty Member?

Yes

No

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* 4. If yes, please provide your position:

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* 5. Please provide emergency contact information in the event that both parents are unavailable.

#1 Name

#1 Relationship

#1 Cell phone

#2 Name

#2 Relationship

#2 Cell phone

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* 6. List the person(s) to whom your child may be released. Please provide a cell phone number.

#1 Name

#1 Relationship

#1 Cell

#2 Name

#2 Relationship

#2 Cell

#3 Name

#3 Relationship

#3 Cell