Fall 2017 PBLOKC
Registration for current session for Principle Based Learning of Kansas City
Family's Last Name/s *
Your answer
Mom's first name *
Your answer
Dad's first name
Your answer
List all Children's names and ages as of September 1, 2017 from oldest to youngest (we want to know about all of your children, but indicate if they not coming to session) *
Your answer
Preferred Email *
Your answer
Preferred phone number (If this is a number that can receive texts, please write "text" next to it. ) *
Your answer
Street address *
Your answer
Other Phone Numbers (please list at least one other person and phone number that would be an emergency contact) *
Your answer
Oldest Child-1 (check the appropriate class, then write child's name in the "other" line.) *
Required
Next Oldest Child-2 (check the appropriate class, then write child's name in the "other" line.)
Next Oldest Child-3 (check the appropriate class, then write child's name in the "other" line.)
Next Oldest Child-4 (check the appropriate class, then write child's name in the "other" line.)
Next Oldest Child-5 (check the appropriate class, then write child's name in the "other" line.)
Next Oldest Child-6 (check the appropriate class, then write child's name in the "other" line.)
We all need to take turns setting up or cleaning up. This means arriving by 9:10 am or staying after 15 minutes. You will be assigned to help two times in the session. What works best for you? *
Anything else? This is your chance to let us know more... allergies? weeks you will be out of town? preferences for mom assignments etc.
Your answer
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