Section 1 of 7
Parent Information
Parent 1 First Name
Parent 1 First Name
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Parent 1 Last Name
Parent 1 Last Name
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Parent 1 Email
Parent 1 Email
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Parent 1 Phone Number
Parent 1 Phone Number
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Parent 2 First Name
Parent 2 First Name
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Parent 2 Last Name
Parent 2 Last Name
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Parent 2 Email Address
Parent 2 Email Address
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Parent 2 Phone Number
Parent 2 Phone Number
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Emergency Contact: Name/Number/Relationship to Child
Emergency Contact: Name/Number/Relationship to Child
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Emergency Contact: Name/Number/Relationship to Child
Emergency Contact: Name/Number/Relationship to Child
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Section 2 of 7
Child(ren) Address
Please complete.
Child's Primary Street Address
Child's Primary Street Address
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City
City
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Zip Code
Zip Code
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Section 3 of 7
Child # 1
Complete for your child.
Child's First Name
Child's First Name
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Child's Last Name
Child's Last Name
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Child's Birthdate
Child's Birthdate
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Gender
Gender
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Female
Male
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Daycare/Preschool/School Attending
Daycare/Preschool/School Attending
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Child's Last Grade Completed
Child's Last Grade Completed
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Date
Time
1.
Not in school
2.
Pre-K (3 year old)
3.
Pre-K (4 year old)
4.
Kindergarten
5.
1st Grade
6.
2nd Grade
7.
3rd Grade
8.
4th Grade
9.
5th Grade
10.
6th Grade
11.
7th Grade and Up
12.
Add option
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Allergies/Special Needs/Alerts
Allergies/Special Needs/Alerts
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Do you have any other children to register?
Do you have any other children to register?
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Yes
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Section 4 of 7
Child # 2
Complete for your next child.
Child's First Name
Child's First Name
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Child's Last Name
Child's Last Name
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Child's Birthdate
Child's Birthdate
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Gender
Gender
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Daycare/Preschool/School Attending
Daycare/Preschool/School Attending
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Child's Last Grade Completed
Child's Last Grade Completed
Question Type
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Date
Time
1.
Not in school
2.
Pre-K (3 year old)
3.
Pre-K (4 year old)
4.
Kindergarten
5.
1st Grade
6.
2nd Grade
7.
3rd Grade
8.
4th Grade
9.
5th Grade
10.
6th Grade
11.
7th Grade and Up
12.
Add option
…
Answer key
(0 points)
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Allergies/Special Needs/Alerts
Allergies/Special Needs/Alerts
Question Type
Short answer
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Date
Time
Answer key
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Do you have any other children to register?
Do you have any other children to register?
Question Type
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Time
Yes
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No
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add "Other"
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Section 5 of 7
Child # 3
Complete for your next child.
Child's First Name
Child's First Name
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Paragraph
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Child's Last Name
Child's Last Name
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Time
Answer key
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Child's Birthdate
Child's Birthdate
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Gender
Gender
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Time
Female
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add "Other"
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Daycare/Preschool/School Attending
Daycare/Preschool/School Attending
Question Type
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Multiple choice grid
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Time
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Child's Last Grade Completed
Child's Last Grade Completed
Question Type
Short answer
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Dropdown
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Rating
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Multiple choice grid
Checkbox grid
Date
Time
1.
Not in school
2.
Pre-K (3 year old)
3.
Pre-K (4 year old)
4.
Kindergarten
5.
1st Grade
6.
2nd Grade
7.
3rd Grade
8.
4th Grade
9.
5th Grade
10.
6th Grade
11.
7th Grade and Up
12.
Add option
…
Answer key
(0 points)
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Allergies/Special Needs/Alerts
Allergies/Special Needs/Alerts
Question Type
Short answer
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Multiple choice grid
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Date
Time
Answer key
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Do you have any other children to register?
Do you have any other children to register?
Question Type
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Time
Yes
Continue to next section
No
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add "Other"
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Section 6 of 7
Child # 4
Complete for your next child.
Child's First Name
Child's First Name
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Paragraph
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Child's Last Name
Child's Last Name
Question Type
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Time
Answer key
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Child's Birthdate
Child's Birthdate
Question Type
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Multiple choice grid
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Date
Time
Answer key
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Gender
Gender
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Date
Time
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add "Other"
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Daycare/Preschool/School Attending
Daycare/Preschool/School Attending
Question Type
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Paragraph
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Multiple choice grid
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Date
Time
Answer key
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Child's Last Grade Completed
Child's Last Grade Completed
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
1.
Not in school
2.
Pre-K (3 year old)
3.
Pre-K (4 year old)
4.
Kindergarten
5.
1st Grade
6.
2nd Grade
7.
3rd Grade
8.
4th Grade
9.
5th Grade
10.
6th Grade
11.
7th Grade and Up
12.
Add option
…
Answer key
(0 points)
Loading...
Allergies/Special Needs/Alerts
Allergies/Special Needs/Alerts
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Do you have any other children to register?
Do you have any other children to register?
Question Type
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Multiple choice grid
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Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
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add "Other"
…
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(0 points)
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Section 7 of 7
Child # 5
Complete for your next child.
Child's First Name
Child's First Name
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
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Date
Time
Answer key
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Child's Last Name
Child's Last Name
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Child's Birthdate
Child's Birthdate
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Gender
Gender
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Female
Male
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Daycare/Preschool/School Attending
Daycare/Preschool/School Attending
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Child's Last Grade Completed
Child's Last Grade Completed
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
1.
Not in school
2.
Pre-K (3 year old)
3.
Pre-K (4 year old)
4.
Kindergarten
5.
1st Grade
6.
2nd Grade
7.
3rd Grade
8.
4th Grade
9.
5th Grade
10.
6th Grade
11.
7th Grade and Up
12.
Add option
…
Answer key
(0 points)
Loading...
Allergies/Special Needs/Alerts
Allergies/Special Needs/Alerts
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
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