STRIVE Membership Form

Parent/Guardian

Parent/Guardian

Membership Information

Please complete the following section as thoroughly as possible. This information enables us to plan a safe and successful experience for the member

Please check any that apply and add any additional under “other”
Please list the food, reaction, and treatment as applicable

Behavior Concerns

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PHOTO RELEASE

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Transportation Alert

(Alerts us to people you DO NOT want to pick up the student) As a parent or legal guardian, I DO NOT authorize my students to be released/picked up by the following persons: