JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Summer Enrollment: Elementary
Please fill out the information below
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's Name: First and Last
*
Your answer
Child's Age
*
Your answer
DOB
*
MM
/
DD
/
YYYY
Grade Child Just Finished
*
Choose
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Parent 1 Name
*
Your answer
Address Parent 1 (if the same as child's, put "same")
*
Your answer
Parent 1 Phone
*
Your answer
Parent 2 Name
Your answer
Address Parent 2 (if the same as child's, put "same")
Your answer
Parent 2 Phone
Your answer
Parent 2 E-Mail
Your answer
Payment Plan
*
Full Pay (Full Payment Due May 10)
Half Pay (Half Pay Due May 10; Half Pay Due June 10)
Payment Type
*
EFT (current families already using EFT, choose this option)
Credit Card
Check
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Children's House.
Report Abuse
Forms
