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TTWS Registration Form 2018-2019
Please include all information
Child's Name *
Your answer
Child's Date of Birth *
MM
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DD
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YYYY
Child's Sex *
Required
Siblings - name and age *
Your answer
Parent #1 *
Your answer
Parent #1 Address *
Your answer
Parent #1 Phone number *
Your answer
Parent #1 Email *
Your answer
Parent #2 *
Your answer
Parent #2 Address *
Your answer
Parent #2 Phone number *
Your answer
Parent #2 Email *
Your answer
Choose one *
Days of the Week (1st Choice) Please Note 4 year old class options ONLY (Monday - Thursday OR Monday - Friday *
Your answer
Days of the Week (2nd Choice) *
Your answer
Child's Pediatrician *
Your answer
Allergies *
Allergies - please explain any allergies that child may have *
Your answer
Hospital Preference *
Emergency Contact #1 (Other than Parents) *
Your answer
Emergency Contact #2 (other than Parents) *
Your answer
Name of person filing out this form *
Your answer
Today's date *
MM
/
DD
/
YYYY
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