Passport to Learning & Wellness

Winter 2018 -2019 Registration

Participant Information

Grade 2018*

School*

Gender of your child*

Student Name*

Parent Email*

Parent Name*

Parent Phone Number*

Emergency Contact Name*

Emergency Contact's Phone Number*

Registration Options*

I qualify for free lunch
I qualify for reduced lunch
I do not qualify for free or reduced lunch

Approved Pick Up List*

Food Allergies or Health Restrictions*

I give permission for my child to be photographed/ videotaped by the Passport to Learning Team for print and website content*

My child has an IEP*

My Child has a 504 Plan*

If you are interested in viewing the Enrichment and Wellness Options prior to enrolling please click on the following link below.

Grades 6-8 Passport to Learning & Wellness Information Packet

RegFox Event Registration Software

Event Registration Software by RegFox