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Student Information

Please have a Parent / Adult Responsible for the Student complete the online Registration Form.
Student Name
(Optional)
Which school do you attend?
Which grade are you in?
What hour do you have English class?

Parent(s) / Adult(s) Responsible for Student

1. Parent/Adult Responsible for Student
2. Parent/Adult Responsible for Student
(optional)

In Case of Emergency

Additional Emergency Contact - Not Already Listed Above
Name

Transportation

Transportation TO the Alden B. Dow Home and Studio
Transportation HOME is the responsibility of the Parent / Adult Responsible for Student.

Please be prompt for pick-up at 4:45 pm at the Alden B. Dow Home and Studio (315 Post Street - (989) 839-2744).

Consent

Parent / Adult Responsible for Student, please complete this section.
Student may receive emergency medical treatment if necessary.
I give permission to photograph the student and use images for publicity.
I confirm my student will be picked up from the Alden B. Dow Home and Studio at 4:45 pm by one of the adults listed on this registration form.
  • 315 Post Street, Midland, MI 48640
  • (866) 315-POST | (989) 839-2744
  • info@abdow.org

© 2021 Alden B. Dow Home & Studio, All Rights Reserved. | Site By DCTree Marketing

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