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Dharma School Student Registration Form
2021-2022 Gardena Buddhist Church Registration Form (One student per form)
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* Indicates required question
Student's Name:
*
Your answer
Birth Month & Year (MM/YYYY)
*
Your answer
Grade:
*
Choose
Nursery
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies:
Your answer
Address
*
Your answer
Student's Email (required for 9th - 12th grades)
Your answer
Emergency Contact Name
*
Your answer
Emergency Cell Phone Number (no dashes)
*
Your answer
Mother/Guardian Name:
*
Your answer
Mother/Guardian Cell Phone Number (no dashes)
*
Your answer
Mother/Guardian Email:
*
Your answer
Father/Guardian Name:
*
Your answer
Father/Guardian Cell Phone Number (no dashes)
*
Your answer
Father/Guardian Email
*
Your answer
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