Enrollment
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  • Parent/Guardian Information

    Please complete the following section with the contact information for the parent/guardian of the student(s) you are enrolling. This will also be the first person we contact in the event of an emergency. 

    • *
      First Name
    • *
      Last Name
    • Relationship to student(s)
    • Address1
    • Address2
    • City
    • Zip Code
    • State
    • *
      Phone
    • *
      Email
  • Emergency Contact

    In the event that the parent/guardian listed above cannot be reached, who should we contact? You can list two emergency contacts. 

    • *
      First Name
    • *
      Last Name
    • Relationship to student(s)
    • Address1
    • Address2
    • City
    • Zip Code
    • State
    • *
      Phone
    • *
      Email
  • *Do you grant Homeroom Education, Inc. permission to release your student(s) into the care of this person?
    • First Name
    • Last Name
    • Relationship to student(s)
    • Address1
    • Address2
    • City
    • Zip Code
    • State
    • Phone
    • Email
  • Do you grant Homeroom Education, Inc. permission to release your student(s) into the care of this person?

That's all, folks!

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