Tuesdays at Cascadia: Student Enrollment Form
The enrollment form provides us with the important information we will need to best care for your child(ren). Thank you for taking the time to fill this out completely. If there is any additional information or question please do not hesitate to contact us directly at cascadialearning@gmail.com. If you have not yet reviewed your options, details about the program can be found on the registration form here: https://docs.google.com/forms/d/e/1FAIpQLSeuHveI-yX_dPZmKcpV53jvxAsEqyu67Ks8Pbmbz03Ujb_X-g/viewform
Today's Date *
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Names of Parents/Guardians *
Your answer
Address *
Your answer
Phone Numbers *
Your answer
Emails *
Your answer
Name and Phone Number for 2 Emergency Contacts *
Your answer
Name and Phone Number of Primary Health Care Provider *
Your answer
Insurance - Name of medical insurance company, all insurance numbers, and name of primary insured *
Your answer
Child 1 Name and DOB
Your answer
Does this child have any life-threatening or severe medical conditions or allergies? Please list any significant health conditions we should be aware of. *
Your answer
Does your child have any special emotional needs or require any special accommodations? If yes, please explain. *
Your answer
Has your child ever been diagnosed or labeled with a developmental or learning disability? If yes, please explain.
Your answer
Tell us more about your child. What are they interested in learning? What are their hobbies?
Your answer
Does your child have any dietary restrictions? If yes, please explain. *
Your answer
Is there anything not covered by the above questions that you would want us to know about your child? *
Your answer
Child 2 Name and DOB (If applicable)
Your answer
Does this child have any life-threatening or severe medical conditions or allergies? Please list any significant health conditions we should be aware of.
Your answer
Does your child have any special emotional needs or require any special accommodations? If yes, please explain.
Your answer
Has your child ever been diagnosed or labeled with a developmental or learning disability? If yes, please explain.
Your answer
Tell us more about your child. What are they interested in learning? What are their hobbies?
Your answer
Does your child have any dietary restrictions? If yes, please explain.
Your answer
Is there anything not covered by the above questions that you would want us to know about your child?
Your answer
Child 3 Name and DOB (If applicable)
Your answer
Does this child have any life-threatening or severe medical conditions or allergies? Please list any significant health conditions we should be aware of.
Your answer
Does your child have any special emotional needs or require any special accommodations? If yes, please explain.
Your answer
Has your child ever been diagnosed or labeled with a developmental or learning disability? If yes, please explain.
Your answer
Tell us more about your child. What are they interested in learning? What are their hobbies?
Your answer
Does your child have any dietary restrictions? If yes, please explain.
Your answer
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