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2022/23 New FDC Student Registration
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CONTACT #1
Parent / Guardian Name (First Last)
*
Your answer
Relationship (Mother, Father, Grandmother, Caregiver, etc.)
*
Your answer
Address (Street, City, State, Zip)
*
Your answer
Cell Phone
*
Your answer
Home Phone
Your answer
Email
*
Your answer
CONTACT #2
Parent / Guardian Name (First Last)
Your answer
Relationship (Mother, Father, Grandmother, Caregiver, etc.)
Your answer
If different than Contact #1 - Address (Street, City, State, Zip)
Your answer
Cell Phone
Your answer
If different than Contact #1 - Home Phone
Your answer
Email
Your answer
NAMES OF THOSE AUTHORIZED TO PICK-UP YOUR CHILD
Authorized Pick-up Name / Phone Number #1
Your answer
Authorized Pick-up Name / Phone Number #2
Your answer
EMERGENCY CONTACT(S)
Emergency Contact #1 (First Last)
*
Your answer
Emergency Contact #1 Relationship to Student(s)
*
Your answer
Emergency Contact #1 Phone Number
*
Your answer
Emergency Contact #2 (First Last)
Your answer
Emergency Contact #2 Relationship to Student(s)
Your answer
Emergency Contact / Pick-up #2 Phone Number
Your answer
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