Paramount Education Classes – Student Registration Form Student's First Name*Student's Last Name*Student's Age*Student's birthday*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Select the grade the student is currently enrolled*Select Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeGender*Select GenderFemaleMaleOther- please specifySchool currently attending*Your InformationYour First Name*Your Last Name*Relationship to Student*Home Phone*Cell Phone*Email 1:*Street Address (Mailing Address)*City*State*Zip Code*Other Email: (Include anyone you'd like to receive correspondence from the Paramount Theatre)Emergency Contact (include yourself)Emergency Contact 1*Relationship to Camper*Emergency Contact 1 Phone*Email 1*Emergency Contact 2Relationship to CamperEmergency Contact 2 PhoneEmail 2Medical InformationPlease list any medical (physical and/or developmental) conditions that we should know about. If there aren't any please, just write "None"*(Maximum response 255 chars, approx. 5 rows of text) Any medications we should know about?*(Maximum response 255 chars, approx. 5 rows of text) Please read the Policies and Procedures for Paramount Education.I have read and understand the policies and procedures*Please select responseYesNoHow did you hear about our classes?*Please select responseSubscriber to the ParamountParamount FacebookParamount WebsiteFriends/FamilyOtherQuestions or comments?