Midtown Registration 20-21
Please complete this in order for your student to remain registered at Midtown Academy.
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Email *
Legal Student Name *
Grade Level 20-21
Clear selection
Gender *
Preferred Name (if applicable)
Medical Information:  Please check all that apply. *
Required
Please list all allergies the student has if applicable.
Legal Guardian 1 Name *
Legal Guardian 1 Complete Address *
Legal Guardian 1 Cell# *
Legal Guardian 1 Work# *
Legal Guardian 1 Home#
Legal Guardian 1 Email *
Legal Guardian 1 Occupation/Employer Name *
Legal Guardian 2 Name *
Legal Guardian 2 Complete Address *
Legal Guardian 2 Cell# *
Legal Guardian 2 Work# *
Legal Guardian 2 Home#
Legal Guardian 2 Email *
Legal Guardian 2 Occupation/Employer Name *
Emergency Contact #1 : Please provide name, relation, email, cell#, work# *
Emergency Contact #2 : Please provide name, relation, email, cell#, work# *
Emergency Contact #3 : Please provide name, relation, email, cell#, work# *
Photograph/Media Release:  I  ( do give / do not give ) my child permission to be photographed or videoed at The Midtown Academy for purposes of magazines and newspaper articles, advertisements for the school, for use on the school's website, and other publicly and/or marketing strategies.I waive any right to notice or approval of any use of photographs which the Midtown Academy or its partners/agents make or authorize, and I release, discharge and agree to save harmless The Midtown Academy and its agents. Licenses, and assigns, from any claim or liability in connection with the use of photographs as aforesaid or by virtue of any alteration processing or use thereof in composite form. *
My child  (does have/does not have) permission to go on Educational/Neighborhood walks and Library visits for the duration of her/his academic career at the The Midtown Academy. *
Internet and Electronic Usage:  Students at The Midtown Academy use computers and the Internet lo enhance their education and practice technology skills. They conduct research, seek information, and create presentations using various programs and tools. To ensure the appropriate educational use of these resources, the Baltimore City Public School System, students, teachers, and parents/guardians must all work together with a shared understanding. While BCPSS provides safely filters for Internet access, it is equally important that students go on the Internet only as guided by school instructors. Parents and guardians also should be directing students in age-appropriate and safe uses of online resources. By signing this legally binding document, parents/guardians, students and teachers all accept their responsibilities toward this end. Midtown administrators and teachers may limit or withdraw computer use and privileges at any time for inappropriate use of computers or the Internet.I have read and accept the Internet and Electronic Device Usage Agreement. I hereby agree to comply with the above described conditions: *
Dismissal Procedures: Please note that After Care programs listed require registration and confirmation of registration. *
Required
Please list the name and relation of all people that have permission to pick up your child.  Example:  Suzanne Penny/Neighbor *
Midtown may share my email with PTO for class and school communications. *
If you have had any custody or other legal changes, please provide legal documentation to Ms. Penny.
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