Student Information Form

Fill out student information here after enrolling your student in an Academy course.

Student's Name*
A nickname can be included in (parentheses) in the first name box. Thank you!
First Last
Nickname
If your child has a nickname, list it here.
Student's Birthdate*
Make sure you select the appropriate birth year!
MM slash DD slash YYYY
Student's Home Phone*
Student's Cell Phone
Student's Address*
Street Address Address Line 2 City State ZIP Code
Student's Email
If different from primary parent/guardian’s email.
Student's Race*
School District*
Primary Emergency Contact(s)
Designate up to two legal parent/guardians.
Name of Legal Parent/Guardian 1*
First Last
Relationship to Child Legal 1*
Legal Guardian 1 Email*
Legal Guardian 1 Home Phone*
Legal Guardian 1 Cell Phone
Legal Guardian 1 Work Phone
Legal Guardian 1 Address
If different from student's address.

Street Address Address Line 2 City State ZIP Code
Add Another Guardian?
- Yes
Name of Legal Parent/Guardian 2
First Last
Relationship to Child Legal 2*
Legal Guardian 2 Email
Legal Guardian 2 Home Phone
Legal Guardian 2 Cell Phone
Legal Guardian 2 Work Phone
Legal Guardian 2 Address
If different from legal guardian 1.

Street Address Address Line 2 City State ZIP Code
Photograph and Video Release
I understand that photos or videos of students may be taken during classes for such purposes as publicity, illustration, advertising, and Web content.
Parent/Legal Guardian Signature*
Date*
MM slash DD slash YYYY
Medical Information/Learning Challenges
Fulton’s Academy of Theatre encourages children of all abilities to participate in the theatre arts. Through open communication with parents and teachers, appropriate supports that are within our resources provide each student the most successful environment. If your child has a medical condition or learning challenge that you can report to our professional teaching artist, please detail it here. This information will be strictly confidential, and used so that we can best meet your child’s individual needs. A Fulton staff person may contact you prior to the first day of class to discuss your child based on the information you share.
My child has a medical/learning challenge that I would like to share with the teaching artist staff.
Title of course your child is registered to attend.*
What information would you like to share with us about your child regarding physical, cognitive, developmental concerns, and/or learning disability?*
Does your child have previous experience in the theatre arts classes/workshops?
How can we best meet the needs of your child? List any social, behavioral or learning strategies that work best for him/her.
Would you like to share your child's interests and favorite activities?
What are your goals for your child as a participant in the Fulton's Academy of Theatre?

Primary Emergency Contact(s)

Photograph and Video Release

Medical Information/Learning Challenges