Register - TRAFFIX

Account Information

Username

E-mail Address*

Password*

Confirm Password*

The password must be minimum 8 characters long. It must be a combination of atleast one uppercase letter, atleast one lowercase letter and atleast one number.

Parent Information

Parent Details

Parent 1/Guardian - First Name*

Parent 1/Guardian - Last Name*

Relationship to Student

Parent 2/Guardian Name

Parent 2/Guardian Relationship to Student

Contact Details

Home Phone

Parent/ Guardian Cell Phone #1*

Parent/ Guardian Cell Phone #2

Email - Alternate #1

Email - Alternate #2

Primary Address

Street Number*

Street Name*

City*

State*

Zip Code*

Secondary Address (optional)

Secondary Address

PO Box

Student Information

Student (1)

Student Full Name*

School*

Grade*

Student Cell Phone

Student (2)

Student Full Name

Student School

Student Grade

Student Cell Phone

Student (3)

Student Name

Student School

Student Grade

Student Cell Phone

Student (4)

Student Name

Student School

Student Grade

Student Cell Phone

Only fill in if you are not human