Registration

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    Child Registration Form

    Registering for:

    Personal Information

    Child's Name:*

    Address:*

    Date of Birth:*

    Phone:*

    Main Email:*

    Legal Guardian Information

    Mother/Guardian Full Name:

    Mother/Guardian Employment:

    Mother/Guardian Phone:

    Mother/Guardian Email:

    Father/Guardian Full Name:

    Father/Guardian Employment:

    Father/Guardian Phone:

    Father/Guardian Email:

    Pick-Up/Emergency Contact

    Emergency Contact 1 Name:

    Emergency Contact 1 Phone:

    Emergency Contact 2 Name:

    Emergency Contact 2 Phone:

    Emergency Contact 3 Name:

    Emergency Contact 3 Phone:

    Medical

    Allergies:

    Medication:

    Permission to Publish

    As part of your child’s educational experience, their photo might be published in conjunction with a school activity, group, or event, such as, classroom bulletin boards, school hallways, Facebook, Instagram, school website, etc. Your signature below grants that permission.

    Child's Name:*

    Signature of Parent/Guardians:*


    Permission to Publish:*