Please complete a separate form for each child.

 

Child's Name
Birthday
Age
Guardian's Names
Address
Home Phone
Cell Phone
e-Mail Address

Select the Grade completed this year:

. Pre-K Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth

Emergency Contact Information:

Name
Relationship
Home Phone
Alt. Phone
Food Allergies
Medical Concerns

People who may pick up my child:

Specific Questions Regarding the Program or Additional Information:

. . .