TIGER Academy Enrollment Form
Starting Date
MM
/
DD
/
YYYY
Grade Entering
Student's Name
Your answer
Gender
Birthdate
MM
/
DD
/
YYYY
Address (Street, City, St, Zip)
Your answer
Mother's/Guardian's Name
Your answer
Home Phone
Your answer
Cell Phone
Your answer
E-Mail
Your answer
Address (if different from above)
Your answer
Employer or School Attending:
Your answer
Work Phone
Your answer
Father's/Guardian's Name:
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Email:
Your answer
Address (if different from above)
Your answer
Employer or School Attending:
Your answer
Work Phone:
Your answer
Emergency Contact 1
Your answer
Relationship to Child
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Emergency Contact 2
Your answer
Relationship to Child
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Days your child will attend morning tutoring
Days your child will attend Tiger Academy After School Program
Please choose one:
Please list any allergies, special medical conditions, including chronic health problems (such as asthma, seizures), behavioral disorders, special needs, etc.
Your answer
Please type your name below to serve as your electronic signature.
Your answer
Submit
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