Student Registration

< Back to Enrollment Forms

Conner Creek Academy East

Student Registration

STUDENT INFORMATION
SPECIAL EDUCATION SERVICES
Siblings
Sibling 1
Sibling 2
Sibling 3
PARENT/GUARDIAN INFORMATION
Parent/Gaurdian 1
Parent/Gaurdian 2
Emergency Information

List two (2) responsible people who will assume temporary care of your child should he/she need to be dismissed due to illness, emergency or inclement weather, should you not be reached.

Emergency Contact #1
Emergency Contact #2
Please list all medical problems and conditions:

I give the school permission to secure medical and/or emergency treatment for my child while in their care.