Please provide the following contact information:

Parent or Guardian First Name
Parent or Guardian Last Name		No blanks allowed in last name
Street Address
	Springfield    Morton    Swarthmore    Other
City	Only if Other is selected in the City Field.
Zip	Only if Other is selected in the City Field.
Home Phone	Numbers only Please. No characters such as "(" , "-" , "."
E-mail

Medical Information:

Medical Insurance Co. (MANDATORY)
Policy Number (MANDATORY)

Please provide your user information:

User Name		Please, No special characters such as "(" , "-" , "."
Password		Please, No special characters such as "(" , "-" , "."
NOTE: The Username/Password System is in place to protect your Personal Information. It will not be used in any other way, except for your protection in the SAA Registration System.
Password Hint: Enter A hint question to jog your memory about your password. Note: Passwords are case sensitive.