Discovery Fields Registration Form
Contact Information: 406-671-9199 or alexadonohue@gmail.com

We are so excited to work with your child through this program! We truly believe that learning is a partnership and want to remind you that you can always reach out if you need anything. Thank you for your trust in us and we will see you soon!
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Full Name of Child *
Date of Birth *
MM
/
DD
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YYYY
Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Home/Mailing Address with Zip Code *
Parent/Guardian Place of Employment with Phone Number *
Emergency Contact Name and Phone Number (please list two) *
List of People Authorized to Pick Up Your Child *
List of Allergies/Anything We Need to Be Aware Of *
Dietary Restrictions *
Preferred Hospital in Case of Emergencies *
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