Online Application Form Please fill out all the required fields and other applicable information. * indicates required field Student's Full Name* School (now attending)* Parent's Name* Email:* Mother's Phone:* Father's Phone:* Address:* How did you learn about Robinson School?* Website Social Media Newspapers and magazines Radio Word of mouth EMERGENCY AUTHORIZATION/CONSENT: I do hereby authorize/consent medical treatment for my child. In the event that my child becomes ill or injured at Robinson School or during a Robinson School related activity, the school is authorized to take one or more of the following actions: a) provide first aid; b) release my child to the person(s) listed below; c) take my child to a hospital and/or give consent for emergency care. Please list any medical, educational, or family circumstances that will help us care for your child and any daily medications. This information will be shared with the adults who are in contact with your child during summer session. 1 Emergency contact name: 1 Relation with child: 1 Emergency Contact Phone Number: Emergency Contact 2 2 Emergency contact name: 2 Relation with child: 2 Emergency Contact Phone Number: Please list persons authorized to pick up child: (Name/Relation) MEDICAL RELEASE: I hereby certify my child is in good health and may participate in all activities.* PUBLIC RELATIONS RELEASE: I hereby permit Robinson School to use, in whole or in part, photographs, videos, written extractions, and voice recordings of my child for the purpose of illustrations, publications and media relations.* Yes, I accept. No, I do not accept. ENROLLMENT AGREEMENT: The student will receive instruction, guidance, and encouragement in keeping with Robinson School’s statement of purpose and values. The school reserves the right to dismiss any student who in conduct, industry, or progress proves not in harmony with school standards.