Student Registration - Global Arts

Name *

First

Last

Gender or Pronouns

Birthdate *//

Language of Preference *

Please check the ethnicity that best describes the student (this information will ONLY be used for statistical purposes. It will NOT be used as a basis for admission or any other discriminatory manner) *

If you indicated "other" please specify below

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Student Email *

Student Cell Phone Number *

School *

Student Grade

Student's Living Arrangement *

Parent/Guardian #1

Optional if over 18- please fill in with NA if this section does not apply

Name *

First

Last

Cell Phone Number *

Work Phone- if applicable

Email *

Language of Preference *

Do you feel comfortable communicating in English? *

Yes
No

Best time to Contact (check all that apply) *

Address- leave blank if same as student address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #2

Optional if over 18- please fill in with NA if this section does not apply

Name *

First

Last

Cell Phone *

Work Phone- if applicable

Email *

Language of Preference *

Do you feel comfortable communicating in English? *

Yes
No

Best time to Contact (check all that apply) *

Address- leave blank if same as student address

Address Line 1

Address Line 2

City

State

Zip Code

Send Mailing to (check all that apply)

Parent/Guardian #1
Parent/Guardian #2

Emergency Information

Emergency Contact #1 (other than parent or guardian) *

First

Last

Cell Phone Number *

Work Phone Number

Student's Medical Plan *

Insurance # *

Physician Name *

Physician Phone Number *

Dentist Name *

Dentist Phone Number *

The following information will not be used as a basis for admission or any other discriminatory manner.

Please indicate if the student has any physical or medical needs

If you indicated "allergies" or "other" above please specify below

Has the student received counseling or emotional support in the past? *

Is the student currently receiving counseling or emotional support? *

Does the student have an IEP? *

May your student be given the following if needed?

Aspirin or Tylenol *

Benadryl *

Has the student had any of the following? *

Please indicate the year your student received their vaccine for the following

Tetanus *

Diphtheria *

Whooping Cough *

Polio *

Mumps *

Measels *

German Measels *

Medical Authorization

Should it be necessary for the student, parent(s), and/or guardian listed above to receive medical care while participating with Global Arts and/or any activities with which it is affiliated, I/we hereby give Global Arts personnel permission to use their judgement in obtaining that care. I/We also give permission to the physician selected by Global Arts personnel to render medical care that s/he deems necessary and appropriate. I/We understand that Global Arts has no insurance covering medical or hospital costs incurred by any participant and, therefore, any cost incurred for such treatment will be entirely my/our responsibility.

I agree- Parent/Guardian #1 Signature

I agree- Parent/Guardian #2 Signature

I agree- Student Signature (only if over 18)

Policies & Contracts

Please read the following policies and contracts found on our website with your student and check the corresponding box indicating that you have read, understand, and agree to their contents. Please sign to indicate you have read, understand and agree to their contents.

Checkboxes

I agree- Student Signature *

I agree- Parent/Guardian #1 Signature

I agree- Parent/Guardian #2 Signature

Upload Documents

Please upload PDFs or clear, readable photos of the following documents. If you do not have electronic versions, you may mail or drop off copies at Bishop Conaty ATTN: Global Arts:

Most Recent Report Card

Click or drag a file to this area to upload.

Please attach a copy of a recent report card or progress report received by your child. It will NOT be used as a basis for admission or any other discriminatory manner just for us to get a better sense of where your student is academically.

Income Verification- only for students applying for scholarships

Click or drag a file to this area to upload.

Please attach either a copy of the first page of your most recent tax return (1040 Form) or a letter from your child's school stating that he/she participates in the free or reduced price lunch program. We do not accept W-2 forms, 1099 forms, or check stubs.