HES Daycare Registration
Last Name *
of student
Your answer
First Name *
of student
Your answer
Middle Name
of student
Your answer
Grade *
Your answer
Homeroom Teacher - 2018/2019
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender
Ethnicity *
Primary Language
Address *
Your answer
Phone/Home
Your answer
Phone/Cell
Your answer
Phone/Work
Your answer
Preferred Method of Contact
Email Address
Your answer
Lives with
Special Needs
(allergies, medications, diet, etc.)
Your answer
Service Needed
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