CHA Re-Registration

INFORMATION UPDATE FORM

           
  Date: New Grade:          Male:  Female:   
  Students Name:  Last, First, MI      
Have you changed your home address in the last year?

Yes:   No:

  If Yes, Enter New Address Below   
           
  Have your contact information changed?

Yes:   No:

  If Yes, Enter Information Below   
Home Phone: E-Mail:      
Father's Work Phone: Father's Cell Phone:      
Mother's Work Phone: Mother's Cell Phone:      
  Has your Emergency Contact changed?

Yes:  No:

  If Yes, Enter Update Below

   
  Emergency Contact Information         
           
           
           
  Did your child develop allergies in the last year?

  Yes:  No:

  If Yes, New Medical Waiver Required

   
  Are there changes to your pick up Instructions?

  Yes:  No:

  If Yes, New Authorization Form Required