New Student Form

Student Application

Student's Grade

6th

7th

8th

Campus Location

District 4 - Woodruff

District 5 - Beech Springs

Student's DOB:

First name

Age

Last name

Address

Home Phone

Student's Cell Phone

Allergies

Current Medications:

Name of Parent or Guardian (who lives with student):

Parent or Guardian's Cell Phone:

Parent/Guardian Email:

Emergency Contact

Relationship

Emergency Contact Phone Number:

I, the parent/guardian of this student have read and agree with the policies & procedures manual for ROAD678. I have knowledge and agree with the disciplinary policies of ROAD678. I acknowledge by signing this form below that I will adhere to the policy & procedures that have been put before me and that I will reiterate to my student to participate in ALL ROAD 678 activities.

Parent/Guardian Signature

Select a date

Student Signature

Select a date

Yes, I give my permission to my student to be photographed or videoed and pictures posted to social media or on the website for ROAD678.