AASM Registration Form 21/22

*Student First Name:

*Student Last Name:

*Student Email (NA if no email):

*Address:

*City:

*State:

*Zip Code:

*Student Cell Phone (NA if no cell):

*Gender:

*Birthdate:

*What grade are you in 2021/22?:

*What school do you attend?:

What church do you attend?:

Allergies or special dietary concerns:

*Parent 1: First Name:

*Parent 1: Last Name:

*Parent 1: Cell Phone:

Parent 1: Home Phone:

*Parent 1: Email:

Parent 2: First Name:

Parent 2: Last Name:

Parent 2: Cell Phone :

Parent 2: Home Phone:

Parent 2: Email:

Feel free to share any additional info that would be helpful for us to know.: