Returning Student(s) Information Updates Parent/Guardian InformationParent/Guardian 1 Last Name *Parent/Guardian 1 First Name *Parent/Guardian 1 Email Address *Parent/Guardian Phone Number *Parent/Guardian 1 Relationship to Student *Please select an option below.MotherFatherGrandmotherGrandfatherOtherParent/Guardian 1 OccupationSpecial skills or talents the parent/guardian is wiling to share with L.O.L.A.?Do you have additional parents/guardians you would like to add? *Please select an option below.YesNoADDITIONAL PARENT/GUARDIAN INFORMATIONParent/Guardian 2 Last NameParent/Guardian 2 First NameParent/Guardian 2 Email AddressParent/Guardian 2 Phone NumberSTUDENT INFORMATIONStudent Last Name *Student First Name *Student Date of Birth *Student T-Shirt Size *Please select an optionYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLStudent Mailing Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePlease list any allergies, medical conditions or and/or medication needs below:With whom does the student live? *Mother & FatherMother OnlyFather OnlyMother & StepfatherFather & StepmotherGrandparentsOtherParents are: *Please select an option below.MarriedDivorcedSeparatedWidowedPreferred Name/NicknameGender *Please select an option below.MaleFemaleDo you have an additional student you would like to add? *Please select an option below.YesNoStudent 2 Last Name *Student 2 First Name *Student 2 Date of Birth *Student 2 T-Shirt Size *Please select an optionYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLStudent 2 Mailing Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePlease list any allergies, medical conditions or and/or medication needs below:With whom does the student live? *Mother & FatherMother OnlyFather OnlyMother & StepfatherFather & StepmotherGrandparentsOtherParents are: *Please select an optionMarriedDivorcedSeparatedWidowedPreferred Name/NicknameGender *Please select an option below.MaleFemaleDo you have an additional student you would like to add? *Please select an optionYesNoStudent 3 Last Name *Student 3 First Name *Student 3 Date of Birth *Student 3 T-Shirt Size *Please select an optionYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLStudent 3 Mailing Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePlease list any allergies, medical conditions or and/or medication needs below:With whom does the student live? *Mother & FatherMother OnlyFather OnlyMother & StepfatherFather & StepmotherGrandparentsOtherParents are: *Please select an optionMarriedDivorcedSeparatedWidowedPreferred Name/NicknameGender *Please select an option below.MaleFemaleAdditional InformationPreferred Hospital (In Case of Emergency): *Emergency Contact Name (First, Last) - other than parents/guardians listed above: *Emergency Contact Phone Number *Authorized Pickup Person (First, Last) - other than parents/guardians listed above: *Additional Authorized Pickup Person (First, Last) - other than parents/guardians listed above:Additional Authorized Pickup Person (First, Last) - other than parents/guardians listed above:Please include my child(ren) in the School Directory. *Please select an option below.YesNoIf Yes - Please provide the preferred Student Name(s), Phone Number, Email Address and Mailing Address you would like shared in the school directory.POLICIES & WAIVERSLiability Waiver *LIABILITY WAIVER - I hereby certify that my child(ren) is/are in good physical condition and do/does not suffer from any disability that prevents or limits his/her participation in all activities conducted by Lavender Oaks Learning Academy. I acknowledge that Lavender Oaks Learning Academy will not assume any responsibility or liability for personal injury or damages caused by the injury. I acknowledge that Lavender Oaks Learning Academy is hosted on a farm and the property owner will not assume any responsibility or liability for personal injury or damages caused by the injury. In the event Lavender Oaks Learning Academy is unable to reach a parent, guardian or any emergency contact, I hereby give permission for my child(ren) to be transported to the nearest hospital for treatment in case of an accident or emergency. I hereby further authorize(s) any of the staff or employees to provide for, approve and authorize health care at hospital.Submit
