Registration

Student First Name: Student Last Name: Birth Date(MM/DD/YYYY): / / Student Email: Student Cell Phone: Gender: Female Male Non-binary/non-conforming Prefer not to respond Current Grade 5 6 7 8 9 10 11 12 Parent/Guardian Parent/Guardian Email Parent Cell Phone Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Zip Suffix Race American Indian/Alaskan Native Asian Black/African American Native Hawaiian/Other Pacific Islander Multi-Racial White/Caucasian Ethnicity Hispanic/Latino Not Hispanic/Latino Family 2 Birth/Adoptive Parents Step and Birth Parent Single Parent Female Single Parent Male Grandparents DCF Foster Parents On Own Other Free/Reduced Lunch receives free/reduced lunch eligible for free/reduced lunch not eligible for free/reduced lunch Emergency Contact Emergency Contact Relationship Emergency Contact Phone Not Authorized for Pick Up Allergies/Medical Conditions Permission to Participate Yes No Permission for PR/Photo Yes No Permission for Anonymous Survey Yes No Parent Signature Captcha