Home
Programs
Schools
Burbank
Glendale
La Crescenta
Tujunga
North Hollywood
Media
Photo Gallery
Videos
News
About
Board of Directors
Contact us
Register online
✕
Register online
Home
Register online
Davidian and Mariamian Educational Foundation
Student Registration and Emergency Card
Student Name
*
First
Last
Birth Date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Birth Place
*
Sex
*
Male
Female
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Home Phone
*
Father's Name
*
First
Last
Business Phone/Cell
*
Mother's Name
*
First
Last
Business Phone/Cell
*
Email
*
School Name
*
School Grade
*
Armenian Grade
*
Health problem required possible emergency action
*
for example diabetes, bee sting allergies, other (specify). Type "none" or N/A if there are no health problems.
I understand that emergency information is required by Education Code section 49408, and I will notify the school IMMEDIATELY of any changes. In case you are unable to reach me during any emergency, you or your agent are authorized to contact, release, and if necessary, transport my child to any of the following:
Name of Doctor
*
First
Last
Phone Number
*
Name of adult relative, neighbor, friend in the local area
*
First
Last
Phone
*
Signature
*