TULIP 2019-2020 Registration Form
Monday - Friday: 2:30-6:00 -- Follows City Schools of Decatur schedule
Address: 2840 Franklin Street, Suite F, Avondale Estates, GA 30002
Contact us at (404) 444-9815 or atlTULIP@gmail.com
Email address *
Welcome!
Parent/Guardian Information
Please list ALL parents, guardians, and/or caregivers below
Parent/Guardian #1: Name *
Your answer
Parent/Guardian #1: Relationship (i.e. mother, father, grandmother, guardian, etc.) *
Your answer
Address *
Your answer
Cell Phone *
Your answer
Home, work, or alternative phone (optional)
Your answer
Parent/Guardian #2: Name
Your answer
Parent/Guardian #2: Relationship (i.e. mother, father, grandmother, guardian, etc.)
Your answer
Address
Your answer
Cell Phone
Your answer
Home, work, or alternative phone (optional)
Your answer
Additional email address (if different than above):
Your answer
Name of additional parent/guardian/caregiver not listed above (if needed):
Your answer
Relationship of additional parent/guardian (i.e. mother, father, grandmother, guardian, sitter, etc.)
Your answer
Emergency Contact:
Please provide a contact that is NOT already listed.
Emergency Contact NAME (not already listed) *
Your answer
Emergency Contact PHONE (not already listed) *
Your answer
Student ONE Information
Student ONE Name: *
Your answer
Student ONE Date of Birth *
Your answer
Student ONE Grade for 2019-2020: *
Your answer
Student ONE School (attending 2019-2020): *
Your answer
What days are you interested in student ONE attending? *
Drop-in days preferred:
Your answer
TRANSPORTATION: Will Student ONE utilize transportation from their CSD school? *
Required
Student ONE Allergies: (please list all below or none) *
Your answer
Student ONE: please list any medical/physical challenges or special care that you know the student may require: (PLEASE NOTE: TULIP is not equipped for all special needs. If your child has special needs, please contact us at atlTULIP@gmail.com to inquire if we can accommodate.) **n/a if not applicable** *
Your answer
Student TWO Information
Student TWO Name:
Your answer
Student TWO Date of Birth
Your answer
Student TWO Grade for 2019-2020:
Your answer
Student TWO School (attending 2019-2020):
Your answer
What days are you interested in student TWO attending?
Drop-in days preferred:
Your answer
TRANSPORTATION: Will Student TWO utilize transportation from their CSD school?
Student TWO Allergies: (please list all below or none)
Your answer
Student TWO: please list any medical/physical challenges or special care that you know the student may require: (PLEASE NOTE: TULIP is not equipped for all special needs. If your child has special needs, please contact us at atlTULIP@gmail.com to inquire if we can accommodate.) **n/a if not applicable**
Your answer
Student Pick-up/Release Approval List:
Please list any adults allowed to pick-up students (other than parents listed) below
List here or n/a: *
Your answer
Is there anything else you'd like us to know?
Your answer
I understand that this form does not guarantee enrollment. *
Required
I understand that should student be accepted into the program, additional signed forms are required. (i.e. Medical release, transportation form, photo release, handbook acceptance, etc.) *
Required
I understand that TULIP is an enrichment program and is exempted from licensure. (enter name below) *
Your answer
I understand that TULIP carries limited liability insurance. (enter name below) *
Your answer
All tuition and fees will be billed to the email address above. Registration will not be considered until fees are paid.
Thank you!
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