Form - S.T.E.P Registration

Please select which S.T.E.P Ahead program that you want to register for:

Program Selection


Student Information
Name:

Age:

Street Address:

City:

State:

Zip Code:

Home Phone:

Mobile Phone:

E-Mail Address:

2021 - 2022 School Year Grade Level:

T-Shirt Size:

Primary Transportation Method:


Family Inforamtion
Parent/Guardian's Full Name:

Relation To Student:

Street Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

E-mail Address:


Emergency Contact
In case of an emergency please contact:

Phone Number:

Relation to Student:

If for any reason I/we cannot be reached, please contact the following person(s) whom I/we hereby authorize to seek emergency medical or surgical care for my/ourchild:

Phone Number:

Relation to Student:


Dietary and Medical Information
Does the student you are registering have any medical issues we should be aware of:

If yes, please explain.:

Does the student have any special diet needs:

If yes, does the student have a disability that requires a special diet:

If yes, describe the major life activities affected by the disability.:

If no, list the medical condition that requires special nutrition or feeding needs.:
Vegetarian, Food Allergy, Other

2011 Bienville Street
New Orleans, LA 70112

Phone: (504) 324-7061
Fax: (504) 459-2602