All fields below are required. Please place an N/A for not applicable if needed.
Help for Birthdate
This information will not be given out.
Help for Student Home E-mail address
(not school email address)
Where parent/guardian can be reached if not at home:
In case of accident or serious illness, if the school is unable to reach me, I hereby authorize the school to call the physician indicated below and to follow instructions given. If it is impossible to contact this physician the school may make whatever arrangements deemed necessary. Please give emergency names other than parents.
Help for Signature
Please write your legal name on this line in place of a signature.
Eaton RESA does not discriminate on the basis of race, color, national origin, sex, (including sexual orientation and transgender identity) disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, “Protected Classes”), in its programs and activities, including employment opportunities. In addition, arrangements can be made to ensure that the lack of English language proficiency is not a barrier to admission or participation. Civil Rights Coordinators are located at 1790 E. Packard Hwy, Charlotte Michigan to handle inquiries regarding the nondiscrimination policies and grievance procedures. Telephone (517) 543-5500.