Student Registration 
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Student Name *
Address *
Birth date *
Students Academic Grade  *
Parent/Guardian Name *
Cell Phone *
Work Phone *
Email *
Parent/Guardian Name
 *
Cell Phone *
Work Phone *
Email *
Emergency Contact 1: Name and Phone number
(Only parents/guardians and emergency contacts will be authorized to pick up a student from Family Learning Alliance without prior authorization from parent/guardian.
 *
Emergency Contact 2:  Name and Phone number *
Emergency Contact 3:  Name and Phone number *
Additional Information: Please include any additional information you would like us to know about your child including, but not limited to curriculum you use, learning style, unique learning needs, your goals for homeschooling, your educational philosophy, etc.  
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