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Pre-Registration is only for students who do not have a Student ID.

" response.write "If the student has a Student ID, but you do know know what it is, please contact a building representative.

" response.write "
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" response.write "

Pre-Registration Card

" response.write year(date()) & " - " & year(date())+1 response.write " Building: " response.write "" response.write "
" response.write "Grade in 2014-2015: " response.write "" response.write "

" response.write "
Student's Legal Name (Last, First, Middle)
Home Phone (format: xxx-xxx-xxxx)
Birthdate
" response.write "Male
Female" response.write "
Address
City
State
Zip Code (at least 5 digits)
First person to call in case of an emergency (name/phone)
Medical Alert/Condition (LEAVE BLANK IF NOT APPLICABLE)

Contact 1 Information (PRIMARY CONTACT)

Contact 2 Information (SECONDARY CONTACT)

Contact 1's First Name:
" response.write "Contact 1's Last Name:
Contact 2's First Name:
" response.write "Contact 2's Last Name:
Home Address (if not child's address)
Home Address (if not child's address)
Employer
Employer
Employer Phone (xxx-xxx-xxxx)
Employer Phone (xxx-xxx-xxxx)
Cell (xxx-xxx-xxxx)
Cell (xxx-xxx-xxxx)
Would you like school information sent by text to this cell?
" response.write " Yes!" response.write "
Would you like school information sent by text to this cell?
" response.write " Yes!" response.write "
E-Mail
E-Mail
Can 'Contact 2' Access Records? " response.write "Yes
Should 'Contact 2' receive emails/mailings regarding student? " response.write "Yes
Should 'Contact 1' or 'Contact 2' be called first in case of emergency or to receive information? " response.write "Contact 1 Contact 2
Information you would like the school to be aware of:
You may release my child to(list in order of preference to be called):
1st Person to call (Name/Relationship)
Phone Number (xxx-xxx-xxxx)
2nd Person to call
Phone Number (xxx-xxx-xxxx)
3rd Person to call
Phone Number (xxx-xxx-xxxx)
Name of Doctor
Hospital Preference (will default to Mercy if nothing entered)
Siblings attending Reeths-Puffer Schools
In case of emergency, illness or accident to my child, I authorize the school to proceed as indicated on this card. I also authorize a doctor of emergency at the facility to proceed with the necessary medical care.
By typing your name below, you agree that the information above is valid and that the signature below is your valid signature.
Digital Signature:
Date:
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