Superior Adventures 2008 Application

Students Name:*
Address:*
Home Phone Number*
Students Gender:
Students Ethnicity:
Parent/ Legal Guardian Name:*
Work Phone Number:*
Email Address:
Grade Student is Entering in Fall 2008:*
Does this student have any special needs we should be aware of?*
In case of Emergency who should we contact?*
Relationship to student:*
Emergency Contact Number:*