Student Visit Application Form

Student Visit Application Form
Student Last Name*
Student First Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Applying to Grade*
Current Grade
Applying for Academic Year*
Current School
Health Card Number
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Contact Information
Parent/Guardian #1 Last Name*
Parent/Guardian #1 First Name*
Home Address*
Street Address City ZIP / Postal Code
Cell Phone*
Work Phone
Home Phone
Email*
Employer/Position
Parent/Guardian #2 Contact Information
Parent/Guardian #2 Last Name
Parent/Guardian #2 First Name
Home Address
Same as Parent/Guardian #1

Street Address City ZIP / Postal Code
Cell Phone
Work Phone
Home Phone
Email
Employer/Position
Medical:
Does your child have any medical needs or allergies?*
Yes
No
If so, provide further detail or impact on school programming (if at all):*
Please add any additional information you would like us to know for your child’s visit

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