MoonSchool Student Registration

Student Information Form

Each student (adult or child) must fill out the following form prior to enrolling in a MoonSchool class. If you have any questions regarding this form, please call 415-255-8205 or e-mail dyan@42ndstmoon.org. If the student is over 18, enter n/a for Parent/Guardian information. If you have filled out a form for your student in the last six months and no information has changed, please click here to go directly to the class registration page.
  • Contact Information

  • Enter as mm/dd/yyyy
  • Enter as xxx-xxx-xxxx

  • Parent/Guardian/Emergency Contact

    All students (regardless of age) must enter at least one emergency contact.
  • Enter as xxx-xxx-xxxx
  • Enter as xxx-xxx-xxxx

  • Parent/Guardian 2/Back-up Emergency Contact

    Students over 18 may enter n/a in this section.
  • Enter as xxx-xxx-xxxx
  • Enter as xxx-xxx-xxxx

  • Health/Medical Information

    All students must fill out regardless of age.
  • Enter "none" if applicable

  • Consent Waiver

  • This field is for validation purposes and should be left unchanged.