Pepitas Explorers
Elementary Enrichment Registration Form
Student's Full Name
Your answer
Student's Birthdate *
Your answer
Student's Grade Going into 2018 *
Your answer
School Student Attends *
Your answer
Student Address *
Your answer
Student Allergies *
Your answer
Student Medical Conditions *
Your answer
Parent/Guardian #1 Full Name *
Your answer
Parent/Guardian #1 Cell Number *
Your answer
Parent/Guardian #1 Email Address *
Your answer
Parent/Guardian #2 Full Name *
Your answer
Parent/Guardian #2 Cell Number *
Your answer
Parent/Guardian #2 Email Address *
Your answer
Where will we meet your child? *
Required
Are you interested in financial aid? *
How did you hear about Pepitas Explorers? *
Your answer
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