Date:

Graduation Year:

Current Grade:

Previous EE Student? Yes No

(Please provide the student's full proper name)

First Name: Middle Name: Last Name:

School:

Gender : Male Female

Home Phone: (Please include area code) (To be used as a primary contact phone number.)

Address:

City: State: Zip:

Date Of Birth:

Email: (To be used as a primary email contact address.)

Allergies (Please list all known:

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For Invitations and Announcements:

Father's Full Name:

Street Address:

City/State/Zip:

Phone (W):

Phone (H):

Phone (C):

Mother's Full Name:

Mother's Address:

City/State/Zip :

Phone (W):

Phone (H):

Phone (C):

Students Activities:

Class Registering for: Date Times: