Editing previous response:

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Parent/Student Directory

Complete this form only if you wish to have your family's information

included in the MHC Academy Parent/Student Directory that will be shared with other families.

Student Information

Complete for all students currently enrolled at the Academy.

Student #1 Name:*

Answer required for "Student #1 Name:"

Student #1 Grade:*

Answer required for "Student #1 Grade:"

Student #1 Cell Phone:*

Answer required for "Student #1 Cell Phone:"

Student #2 Name:

Answer required for "Student #2 Name:"

Student #2 Grade:

Answer required for "Student #2 Grade:"

Student #2 Cell Phone:

Answer required for "Student #2 Cell Phone:"

Student #3 Name:

Answer required for "Student #3 Name:"

Student #3 Grade:

Answer required for "Student #3 Grade:"

Student #3 Cell Phone:

Answer required for "Student #3 Cell Phone:"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Home Phone:*

Answer required for "Home Phone:"

Mother/Female Guardian's Information

Name:*

Answer required for "Name:"

Cell Phone:*

Answer required for "Cell Phone:"

Email Address:*

Answer required for "Email Address:"

Father/Male Guardian's Information

Name:

Answer required for "Name:"

Cell Phone:

Answer required for "Cell Phone:"

Email Address:

Answer required for "Email Address:"

Consent

I grant permission to have my information printed in the MHC Academy Parent/Student Directory which will be distributed to all Academy families.*

Answer required for "I grant permission to have my information printed in the MHC Academy Parent/Student Directory which will be distributed to all Academy families."

Parent/guardian must check here.

Enter full name as signature:*

Answer required for "Enter full name as signature:"

Date:*

Answer required for "Date:"