Returning Student Registration — Alternative Learning Institute

Student Registration Renewal

If you are planning for your child to continue with ALI for the upcoming school year, this form must be completed no later than August 1st. This form should be completed for each year a student is enrolled.

Student Full Name

Include first, middle, and last name(s)

Grade Level

Select the grade level that the student will be entering in September.

Student's Date of Birth

YYYY

Gender

NIB Number

Address

Include house/apartment number and street name

P.O. Box

Student's Medical Conditions

Select ALL medical conditions that affect the student.

None

Asthma

Allergies (specify)

Chronic headaches / migraines

Diabetes

Frequent nosebleeds

Vision problems (requiring glasses/contacts)

Other (specify)

Specify Medical Conditions

If you selected any medical condition above that required a specification, write here.

Primary Contact

Which person do you prefer as the primary/main point of contact for matters pertaining to the student? All information for the person selected should be completed below.

Mother's Name

First Name

Last Name

Cell Phone Number (Mother)

(###)

###

####

Email (Mother)

Father's Name

First Name

Last Name

Cell Phone Number (Father)

(###)

###

####

Email (Father)

Emergency Contact

Please only specify individuals who are at least 18 years old and/or capable of picking up the student if neither parent can be reached.

First Name

Last Name

Student's Relationship to Emergency Contact

Phone Number (Emergency Contact)

(###)

###

####

Acknowledgement

I understand that this form is for RETURNING students only. I acknowledge that the registration fee must be paid to complete the registration process and guarantee a seat for the school year.