Bike Shop Registration Form

Student Information

Student Name

First

Last

Date of Birth

Family Phone (Home or Cell) *

Gaurdian Name

First

Last

Former or Maiden Name

Relationship

Guardian Direct Phone (Home or Cell) *

Work Phone

Guardian Email

Preferred method of contact

Text

Call

Place of Employment

Position

Address *

Address

Adress Line 1

Building/Apartment/Suite #

City

State/Province

Zip/Postal

Country

Is the student a past participant?

Yes

When and for which program was the student a past participant?

School

Grade Level

Is your student a U.S. Citizen or Eligible Non-Citizen?

U.S. Citizen

Eligible Non-Citizen

Eligible Non-Citizen Country of Origin

Primary Language

name="item_meta[451]" id="field_q7lj9" value="" /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> title="Page 4"> listed (on electronic student dashboard) recreational and field trips sights in and surrounding Summit County. students, unless otherwise arranged due to necessity, to regularly scheduled South Street Ministries’ After-School and Summer programming.</li> are authorized to transport my child to the address listed on their Student Participation Application at the conclusion of regularly scheduled South Street Ministries’ After-School or Summer programming to ensure safe travel back to his/her/their place of residence.</li> times of transportation.</li> my child to and from the visiting site, back to The Front Porch Fellowship at 1095 Edison, Akron, Ohio, 44301 or to my listed residence.</li> 4"> listed (on electronic student dashboard) recreational and field trips sights in and surrounding Summit County. students, unless otherwise arranged due to necessity, to regularly scheduled South Street Ministries’ After-School and Summer programming.</li> are authorized to transport my child to the address listed on their Student Participation Application at the conclusion of regularly scheduled South Street Ministries’ After-School or Summer programming to ensure safe travel back to his/her/their place of residence.</li> times of transportation.</li> my child to and from the visiting site, back to The Front Porch Fellowship at 1095 Edison, Akron, Ohio, 44301 or to my listed residence.</li> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />