New Student Registration

Complete this registration to join Friday School. After submitting, you’ll be guided to choose electives.

Student Information

First Name *

Middle Name

Last Name *

Date of Birth

Current Grade

Gender

Home Address

City

State

ZIP

Mother’s Name

Mother’s Email

Mother’s Phone

Father’s Name

Father’s Email

Father’s Phone

Primary Contact Email *

Primary Contact Phone

Allergies

Medications

Relevant Conditions

Physician

Physician Phone

Insurance Carrier

Member / Policy ID

Contact 1 – Name

Relationship

Phone

Contact 2 – Name

Relationship

Phone

Name #1

Name #2

Name #3

I grant permission for my child to appear in school photos/videos.

I have read and agree to Providence Hill Friday School policies. *

Parent/Guardian Signature (type full name)

Date

Required fields marked with *