Student Registration Form Student Registration Parent/Guardian Information Parent/Guardian name * Parent phone * Parent email * Emergency contact name Emergency contact phone Student Information Name of school or group * First Name * Last Name * Student email Student phone Gender Female Male Does Student Require Epi-Pen? Yes No Briefly describe allergy * Does student have any medical issue or prescribed medications to be aware of? Yes No Briefly describe medications or medical issues. * Photography release Yes No You authorize School Time Travel to obtain, store and/or use, without payment any photographs, slides and/or video/digital recordings of your child for public relations, marketing/advertising, and/or internal training purposes. Submit If you are human, leave this field blank.