HAA - Returning Student Application

Returning Student Application 2021-2022
Student's Name:*

First NameMiddle NameLast Name
Grade:*
Baptized?

YesNo
Present Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Emergency Contact:

In case of an emergency call
Contact #1*

First NameLast Name
Home Phone:
Please enter a valid phone number.
Work Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Contact #2*

First NameLast Name
Home Phone:
Please enter a valid phone number.
Work Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Family Information:

Mother & Father Info
Mother's Name:*
Father's Name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Affiliation*
Telephone:
Please enter a valid phone number.
Do you authorize the school to take your child on unscheduled walking trips and scheduled field trips?*

YesNo
Please list other child in your family:
Child 1:

First NameLast Name
age:
Child 2:

First NameLast Name
age:
Child 3:

First NameLast Name
age:
The following individuals are authorized to take my child from the Hartford S.D.A area school at the end of the or any necessary times.
(1) Person's Name:*

First NameLast Name
Relationship:*
(2) Person's Name:

First NameLast Name
Relationship:
(3) Person's Name:

First NameLast Name
Relationship:
My child is allowed to walk home or take the bus.*

YesNo
Parents: Please note that in the event of an emergency, unauthorized individuals desiring to pick up students are required to bring a signed statement from an authorized adult listed above in order for students to be released from the school.
Parent Signature*

Clear
Date

MonthDayYear
Should be Empty:

Returning Student Application 2021-2022

Emergency Contact:

Family Information: