Passport to Learning & Wellness
Spring 2018 -2019 Registration
Participant Information
Student Name
*
Grade 2018
*
(Choose One)
K
1
2
3
4
5
Parent Name
*
Parent Phone Number
*
Parent Email
*
Emergency Contact Name
*
Emergency Contact's Phone Number
*
Approved Pick Up List
*
Food Allergies or Health Restrictions
*
I give permission for my child to be photographed/ videotaped by the Passport to Learning Literary Magazine Team for print and website content
*
(Choose One)
Yes
No
My child has an IEP
*
(Choose One)
Yes
No
My Child has a 504 Plan
*
(Choose One)
Yes
No
Registration Options
*
I qualify for free lunch
I qualify for reduced lunch
I do not qualify for free or reduced lunch
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