Bertha-Hewitt Early Childhood Education Information Request
For more information regarding Bertha-Hewitt Early Childhood, please fill out the following information. If you have questions filling out the information, please call Lisa Wick at (218) 296-1048
Child's Full Name *
Child's Birthday *
MM
/
DD
/
YYYY
Age as of Sept. 1, 2021 *
Mother's Name
Father's Name
Child Lives with (choose one):
Mailing Address
Physical Address (if different from mailing)
Home Phone #
Contact Email Address *
Mothers Cell #
Okay to correspond via texting with Mother's Cell?
Clear selection
Father's Cell #
Okay to correspond through texting with Father's Cell?
Clear selection
Siblings (Names and grade) - ***IMPORTANT - Please list younger siblings also
I am interested in receiving information regarding (please see detailed information under specific program section of the website):
Submit
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