TAG Registration Form (4th and 5th Grade)
Tuesdays from Immediately after school - 5:00pm. 2017-2018 Program Year.
If possible we do accept donations between $10-$20 to help offset costs.
Child's Name
(Last, First Middle
Your answer
Elementary School your child attends
(For possible carpooling)
Grade your child will be in during 17-18 school year
Young Person's Date of Birth
(MM/DD/YYYY)
MM
/
DD
/
YYYY
Young Person's Baptism Date (if known)
(MM/DD/YYYY)
MM
/
DD
/
YYYY
Mother's Name
Your answer
Mother's Address
Your answer
Mother's Email
Your answer
Mother's Phone # (please provide cell # and any other # where you could be reached)
Your answer
Father's Name
Your answer
Father's Address (if different from above)
Your answer
Father's Email Address
Your answer
Father's Phone
(Please give a cell number if that is where you can be reached)
Your answer
Are there concerns of which we should be aware?
(Allergies, custody, behavior or learning challenges)
Your answer
Adult Volunteer Opportunities
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