Registration

Parent & Student Information

Email*

Phone Number* - -

Address*

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Address 1:

City:

Country:

State/Province:

Postal Code:

Parent/Guardian First Name*

Parent/Guardian Last Name*

Second Parent/Guardian First Name

Second Parent/Guardian Last Name

Student Full Name *

Student Grade in 2025-2026 School Year*

School Currently Attending *

T-Shirt Size*

RELEASE FORMS

With whom will your child go home?*

Please list anyone who might be picking-up your child, including you, the parents and/or guardians. For your child's protections, we will not release your child to anyone other than the persons listed below.

Emergency Medical Contact*

List any additional emergency contact(s) and their contact information to be used if your child is seriously ill or injured.

Allergies*

List any allergies that we should be aware of.

Excursion Release*Yes, I consent.

La Pietra will take all precautionary measures to ensure your child's safety on planned excursions. By checking this box, I the parent/guardian, give permission to the La Pietra Pathways to Purpose program to take my child on all excursions by bus or within walking distance. I release La Pietra from responsibility in case of an accident. I further understand that information regarding the excursion will be given prior to the event.

Media Release*Yes, I consent.No, I do not consent.

We, parents/guardians, consent to photography, audio recording, video recording and it's/their release, publication, exhibition, or reproduction to be used for news, web casts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose by La Pietra and its affiliates and representatives. You release La Pietra, its officers and employees, and each and all persons involved from any liability connected with the taking, recording, digitizing, or publication and use of photographs, computer images, video and/or sound recordings.