Face to Face/ Remote Learning Hybrid Registration and Information
This form is to gather information for 6-8 scholars attending face to face and remote hybrid classes. Please submit by Friday, March 26, 2021, at 5:00 pm. Fill a new form out for each scholar who will be attending Face to Face.
Sign in to Google to save your progress. Learn more
Email *
Scholar Last Name *
Scholar First Name *
Scholar's Date of Birth *
MM
/
DD
/
YYYY
Scholar's Grade Level for this new school year (2020-2021) *
Does the scholar have an IEP or 504? *
Does the scholar have any siblings that will also be attending face to face/remote learning? If so please list first names, last names, and grade levels below.
Does the scholar carpool with any other students who are attending face to face/remote learning? If so please list first names, last names, and grade levels below.
Scholar Mailing Address: *
Scholar Physical Address if Different From Above:
Parent 1 Name *
Parent 1 Email *
Parent 1 Phone Number(s) *
Parent 2 Name
Parent 2 Email
Parent 2 Phone Number(s)
Emergency contact(s): Name(s) and phone number(s) *
Do you give consent for your scholar's image to be used on learning videos, social media, or for marketing purposes? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wayne Preparatory Academy. Report Abuse
Google Forms