General Information for Your Child
This is a pre-registration form for a single child. Children must have turned the age of four by July 1, 2019 to be eligible to attend.
Student's FIRST Name *
Your answer
Student's LAST Name *
Your answer
Home Address *
Your answer
City, State ZIP *
Your answer
Parent Email Address *
Your answer
Home Phone *
ex: 123-456-7890
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent's Names *
First and last names please
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Allergies or Special Needs
If none, leave blank.
Your answer
Special Concerns
Are there any other concerns we would need to be aware of (such as custody limitations and pick-up restrictions)?
Your answer
Parent's Church
If none, just leave blank.
Your answer
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