LAM Registration 2020-2021 School Year
*Please Note: Due to the global pandemic, COVID-19, days of care may be altered to follow District and CDC Guidelines
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Email *
Student #1 -  Full Name *
Student #1 - School Name *
Student #1 - Grade Level *
Student #1- Date of Birth *
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DD
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Student #1- Does This Student Have An IEP (individual Education Plan?) *
Student #1- If Yes, Please State The Reason For the IEP
Student #1- Special Considerations/Add'l Info (i.e. custody, food allergies, asthma, etc.) If not applicable, please type "NONE". * Select All That Apply *
Required
Please Explain Any Special Consideration, If None write NONE (I.E If You Checked Food Allergy, Write Peanuts) *
Student #2 - Full Name
Student #2 -  School Name
Clear selection
Student #2 - Grade Level
Student #2- Date of Birth
MM
/
DD
/
YYYY
Student #2- Does This Student Have An IEP (Individual Education Plan?)
Clear selection
If Yes, Please State The Reason For The IEP  
Student #2- Special Considerations/Add'l Info (i.e. custody, food allergies, asthma, etc.) If not applicable, please type "NONE". *Select All That Apply
Please Explain Any Special Consideration, If None write NONE (I.E If You Checked Food Allergy, Write Peanuts)
Student # 3- Full Name
Student #3 - Name
Student #3 - School Name
Clear selection
Student #3 - Grade Level
Student #3- Date of Birth
MM
/
DD
/
YYYY
Student #3- Does This Student Have An IEP (Individual Education Plan)
Clear selection
If Yes, Please State The Reason For The IEP  
Student #3- Special Considerations/Add'l Info (i.e. custody, food allergies, asthma, etc.) If not applicable, please type "NONE". *Select All That Apply
Please Explain Any Special Consideration, If None write NONE (I.E If You Checked Food Allergy, Write Peanuts)
Student #4 - Full Name
Student #4 - School Name
Clear selection
Student #4 - Grade Level
Student #4- Date of Birth
MM
/
DD
/
YYYY
Student #4-Does This Student Have An IEP (Individual Education Plan?)
Clear selection
If Yes, Please State The Reason For The IEP  
Student #4- Special Considerations/Add'l Info (i.e. custody, food allergies, asthma, etc.) If not applicable, please type "NONE". *Select All That Apply
Please Explain Any Special Consideration, If None write NONE (I.E If You Checked Food Allergy, Write Peanuts)
Student #5 - Full Name
Student #5 - School Name
Clear selection
Student #5 - Grade level
Student #5- Date of Birth
MM
/
DD
/
YYYY
Student #5- Does This Student Have An IEP (Individual Education Plan?)
Clear selection
If Yes, Please State The Reason For The IEP  
Student #5- Special Considerations/Add'l Info (i.e. custody, food allergies, asthma, etc.) If not applicable, please type "NONE". *Select All That Apply
Please Explain Any Special Consideration, If None write NONE (I.E If You Checked Food Allergy, Write Peanuts)
Parents Are Required To Provide Asthma Inhalers in a labeled Ziplock Bag *
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