The Learning Tree Registration
2 year olds - are full for 2021-22! Please complete your form and let us know that you would like to be on the waiting list under the session preferred section or comments. We will notify you if we have availability.

3 year olds - are full for 2021-22! Please note that you would like to be put on the waiting list under the session preferred section or comments for the 3s.

4 year olds - are full for Tuesday/Thursday! There are currently THREE openings on Monday/Wednesday remaining for 2021-22.

5 year olds- This class has limited space and is only available on Tuesday/Thursday. There are THREE openings available in the fives class.
Child's Name/Nickname
Requested Session
Clear selection
Any additional comments or requests?
Child's Gender
Clear selection
Child's Age (as of 8/15/2021)
Clear selection
Child's Birthday
MM
/
DD
/
YYYY
Father's Information: name
Father's Personal Information: phone number, address
Father's Information: primary email
Father's Employer Information: employer, position and phone number
Mother's Name
Mother's Personal Information: phone, address
Mothers' Information: primary email
Mother's Employer Information: employer, position and phone number
Please list the names, ages, & schools of other children in your family/household.
Does your child have any health problems? If so, please explain.
Does your child have any seasonal or food allergies? If yes, please explain.
Does your child have any vision, hearing, or speech problems? If yes, please explain.
Does your child wear glasses? If yes, for what & how often?
Are there any medications given regularly to your child? If so, what are they?
Child's Physician: name, office, phone #
Emergency Contact Information: Please list at least two other people (other than a spouse) who are authorized to pick up your child from school or act in your behalf in an emergency. We cannot release your child to anyone without your prior permission. (name, relationship, phone)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy