ScreeningSubmission - Student Health Screening Registration

Lakeland High Girls Registration
Student Heart Check Screening for girls aged 13-18
Date: 05/18/2024

Lakeland High
1630 Bogie Lake Rd, White Lake, MI 48383

Please complete the form below:

Find and select your time slot.

Student First Name

Student Last Name

Gender

Student School

Student Birthday (mm/dd/yyyy)

Parent or Guardian Full Name

Parent or Guardian Email

Parent Phone Number

Address Line 1

Address Line 2

City

State

Zip Code

Comments

How did you hear about our program?

Notes

This registration is for girls aged 13-18. 13 is our minimum age for the screening. Appointments made for children under the age of 13 will be cancelled.

Lakeland High Girls Registration Student Heart Check Screening for girls aged 13-18 Date: 05/18/2024

Lakeland High Girls Registration
Student Heart Check Screening for girls aged 13-18
Date: 05/18/2024