Enroll Your Child

1. Name of Child #1*
2. Grade of Child #1*
3. List Allergies Child #1 if any or None:*
4. Birthdate of Child #1 MM/DD/YYYY*
5. Name of Child #2
6. Grade of Child #2
7. List allergies Child #2 if any or none
8. Birthdate of Child #2 MM/DD/YYYY
9. Name of Child #3
10. Grade of Child #3
11. List allergies child #3 if any or None
12. Birthdate of Child #3 MM/DD/YYYY
13. Name of Child #4
14. Grade of Child #4
15. List allergies child #4 if any or None
16. Birthdate of Child #4 MM/DD/YYYY
17. Child's Last Name:*
18. Father's Name
19. Mother's Name
20. Child's Street Address*
21. City*
22. Zip Code*
23. Child's School District
24. Cell Phone Number*
25. EMail Address*