Higher Ground Middle School Online Registration
Preferred Week:
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Week 1: June 4-8, 2017
Week 2: June 25-29, 2017
First Name
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Middle Initial
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Last Name
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Preferred Name for Name Tag
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Email
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Address
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City
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State
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Zip
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Birth Month
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Birth Day
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Birth Year
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2006
Female
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Home Phone
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Cell Phone
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T-Shirt Size
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Small
Medium
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X-Large
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Parish Name
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Parish Town
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Parent/Guardian First Name 1
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Parent/Guardian Last Name 1
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Parent/Guardian Cell Phone 1
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Parent/Guardian Relationship 1 (e.g. Mother)
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Parent/Guardian First Name 2
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Parent/Guardian Last Name 2
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Parent/Guardian Cell Phone 2
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Parent/Guardian Cell Phone 2
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Parent/Guardian Relationship 2
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Emergency Contact First Name
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Emergency Contact Last Name
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Emergency Phone Contact
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Preferred Week:
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