SBS- La Crosse Fall 2024

**Please fill out all requested information as it will be also be used in our 2024-2025 SBS directory.

Fall semester begins September 11 as
Large Group time.

When you register for your study, It will be for the Fall semester and you will be asked to choose a FIRST and SECOND choice. We hope we will be able to accommodate everyone's first choice, but we appreciate your understanding in advance if we are not able to fulfill your first choice request. Study descriptions can be found here.

You will be ordering your own books if indicated by the description. PLEASE DO NOT order a book until you have gotten an email confirmation on your study.

* Indicates required field

Your Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Birthday (mm/dd) *

Mobile Phone Number *

Home Phone Number *

Email *

Spouse/Partner Information

Name *

First

Last

Hospital/Clinic Affiliation *

Specialty *

Your Children (info for directory)

Please list ALL of your child/children's name(s) and their BIRTH YEAR(S) - even if that child is a grownup, For example: John 2003, Sydney 2005 *

Childcare Information (if no childcare is needed, skip to study choices)**

Emergency Contact Name *

Hospital Preference *

Emergency Contact Phone *

Physician *

Things you should know when caring for my child(ren): *

Child #1 Name *

Child #2 Name *

Child #3 Name *

Child #4 Name *

Birthdate #1 *

Birthdate #2 *

Birthdate #3 *

Birthdate #4 *

Medical Conditions/Allergies #1 *

Needs Childcare #1 *

Potty Trained? #1 *

Medical Conditions/Allergies #2 *

Needs Childcare #2 *

Potty Trained? #2 *

Medical Conditions/Allergies #3 *

Needs Childcare #3 *

Potty Trained? #3 *

Medical Conditions/Allergies #4 *

Needs Childcare #4 *

Potty Trained? #4 *

More Children for Childcare? *

Study Choices

First Choice Study *

Second Choice Study *

Is there any more information that you think we may need? *

Submit

STUDY DESCRIPTIONS

PLEASE DO NOT ORDER BOOKS UNTIL YOU GET CONFIRMATION FROM SBS

Registration for Fall 2024

Spouse/Partner Information

Your Children (info for directory)

Childcare Information (**if no childcare is needed, skip to study choices)

Study Choices

Childcare Information (if no childcare is needed, skip to study choices)**