New Student Registration

Please complete the following form before attending a two.fifty.four event for the first time. This information will allow us to get to know your student as well as know who to contact in the event of an emergency. You will only need to complete this form once.

If you need to make an adjustment to your student’s information (adding or changing an emergency contact, for example), please email us at contact@the254.org with the desired changes.

A parent or guardian must complete this form for their student unless they are at least 16 years old.

Student name

First Name

Last Name

Preferred name

Birthdate

YYYY

Grade

2023-2024 school year

Emergency contact #1 name

First Name

Last Name

Emergency contact #1 relationship to student

Emergency contact #1 phone number

This will be the first number that we contact in the event of an emergency

(###)

###

####

Emergency contact #2 name

First Name

Last Name

Emergency contact #2 relationship to student

Emergency contact #2 phone number

We will contact this number if the first phone number provided does not answer

(###)

###

####

We can't send email to school accounts, so please use another if you'd like us to be able to reach you through email.

I would like to opt-in to email updates from two.fifty.four (including news and upcoming events)

Yes

Allergies

I hereby consent to the use of photographs/videotape taken while at 254 Teen Center for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources)

Yes

Additional student notes, if applicable