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KUBEMAS INC 2018/19 SIGN UP FORM
Email address *
CHILD'S NAME *
Your answer
CHILD'S BIRTHDATE *
MM
/
DD
/
YYYY
CHILD'S AGE *
Your answer
CHILD'S GRADE *
Your answer
CHILD'S SCHOOL *
Your answer
PARENT 1 NAME *
Your answer
PARENT 1 CEL PHONE NUMBER *
Your answer
PARENT 2/GUARDIAN NAME
Your answer
PARENT 2/GUARDIAN CEL PHONE NUMBER
Your answer
PARENT 2/GUARDIAN EMAIL ADDRESS
Your answer
OTHER PERSON(S) AUTHORIZED TO PICKUP YOUR CHILD
Your answer
CHILD'S ALLERGIES/HEALTH CONCERNS/DIETRY RESTRICTIONS
Your answer
OTHER IMPORTANT INFO YOU WANT US TO KNOW ABOUT YOUR CHILD
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INFORMATION YOU WANT OUR TUTORS TO KNOW AND/OR SUBJECTS YOU WOULD LIKE THEM TO FOCUS ON WITH YOUIR CHILD. EG ART, MATH, SCHOOL HOMEWORK, TEST PREP ETC
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DAYS YOU EXPECT YOUR CHILD TO REGULARLY ATTEND *
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