SMARTe Micro-Preschool Program Onsite Enrollment Form
Child's Name: *
Gender: *
Address: *
DOB: *
MM
/
DD
/
YYYY
Grade: *
ZIP: *
Mother/Guardian Name:
Address (If different:)
Home Phone:
Cell Phone:
Email:
Father/Guardian Name:
Address (if different):
Home Phone:
Cell Phone:
Home Phone:
E-mail:
Who is the child living with? *
Who check out the child from the program? (You can select multiple) *
Emergency Contact If Parents Cannot Be Reached:
Name: *
Relation to child: *
Work phone: *
Home phone: *
Cell phone: *
Submit
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