AASM Registration Form 22/23

*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 2022/23?:
*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.: