Baugo Extended Care
Registration 2018-2019
Student's First Name *
Your answer
Student's Last Name *
Your answer
Address *
Your answer
Student's Birthday *
MM
/
DD
/
YYYY
Grade *
Teacher
Your answer
Primary Parent / Guardian's Name *
Please enter the first and last name of the primary parent. This parent will be responsible for creating a brightwheel account and adding other parents or authorized pick ups to their child's brightwheel account.
Your answer
Primary Parent / Guardian's Cell Phone *
Your answer
Primary Parent / Guardian's Email *
Your answer
Secondary Parent / Guardian's Name
Your answer
Secondary Parent / Guardian's Cell Phone
Your answer
Secondary Parent / Guardian's Email
Your answer
Emergency Contacts / Authorized Pick-up
(Other than Parent listed above) Enter name(s), phone number(s), and relation to child.
Your answer
Allergies *
If none, then please type none.
Your answer
Medications *
If none, then please type none.
Your answer
Special Instructions *
Things we should know about your child.
Your answer
Attending Weekly *
Days Attending *
Required
Approximate Arrival Time *
Time
:
Approximate Pick-up Time *
Time
:
Start Date *
MM
/
DD
/
YYYY
Referred by
Your answer
Handbook *
Required
Photographed *
Required
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