Student Information

Name

Sex

Male Female

Date of Birth

Name of Current School

Street Address

City

Address (cont.)

State

Zip

 

Parent/Guardian Information

Name

Street Address( if different from above)

City

Address (cont.)

State

Home Phone

 

Zip

 

Work Phone

 

E-mail

Emergency Contact

Name

Telephone

 

  TBEA will not release personal information you provide to third parties without your written consent absent court order or other process.