Extended Day Care Registration 2018-2019
Entering Grade *
Your answer
Child's Name (Last, First) *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Male/Female *
Sibling Attending Trinity Lutheran Christian School (Name & Grade)
Your answer
Sibling Attending Trinity Lutheran Christian School (Name & Grade)
Your answer
Sibling Attending Trinity Lutheran Christian School (Name & Grade)
Your answer
Sibling Attending Trinity Lutheran Christian School (Name & Grade)
Your answer
Parent(s) Living with Child (Mother) *
Your answer
Occupation
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Parent(s) Living with Child (Father) *
Your answer
Occupation *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Parent(s) Not Living with Child (Mother)
Your answer
Occupation
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Parent(s) Not Living with Child (Father)
Your answer
Occupation
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
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