Explorers Register Form

* indicates a required answer

REGISTRATION FEE: None

Thank you for your interest in participating in our activity!
Please fill out all the fields below.

PARENT INFORMATION

Parent First Name

Parent Last Name

Address

Cell Phone

Home Phone

STUDENT INFORMATION

Student 1 Name

Student 1 Age

Student 1 Grade

Student 1 Allergies

Student 2 Name

Student 2 Age

Student 2 Grade

Student 2 Allergies

Student 3 Name

Student 3 Age

Student 3 Grade

Student 3 Allergies

If you have more students you want to register please click the register button again.

EMERGENCY CONTACT

In the event of an emergency who should we contact? Please provide two contacts

Full Name

Relationship

Phone number

Full Name

Relationship

Phone number

I authorize my child(ren)'s pictures from the Explorer's meetings to be shared on the NJHSA Facebook page.

Yes

I authorize my child(ren)'s pictures from the Explorer's meetings to be shared on social media by other families within our group.

Yes

Thank you for your registration!

North Jersey Home Schoolers Association