ALC Student Information 2023-2024
Please complete a "Student Information" questionnaire REQUIRED for each registered student, and a *voluntary* student ethnicity questionnaire (no names, just a survey to help satisfy our non-profit agreement).

Student phone numbers & email addresses will NOT be included in our family directory.

Family Directory will include Parent Name, Student Name, Address, Phone & Email of Parent.
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Student Last Name *
Student First Name *
Student Date of Birth *
MM
/
DD
/
YYYY
Student Cell Number
Please include area code with phone number
Student Email Address
Parent Last Name *
Parent First Name *
Parent Contact Phone *
Please include area code with your phone number.
Parent Email Address *
Emergency Contact & Phone Number *
If we cannot reach you, who should we contact in case of emergency? Please include name, phone number, and relationship to student.
Medical Information *
Please list any allergies (food, seasonal, medications, etc.), or other conditions that teachers and staff should be aware of. Also, in case of an emergency, what information would we need to share with an EMT/Paramedic?
Home Address - House Number & Street ONLY *
Home Address - City, State ONLY *
Home Address - Zip Code ONLY *
Photo Release *
Policy: We generally identify students in photos that can appear on our website or Facebook page as "science students," or "car wash helpers." We may use students' first names, but will not use family names (last names) without your permission.
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