Little Cane’s Academy
Name of Child (please include nickname)
Date of Application
Date of Birth (01/01/2000)
Name of parent/s or guardian
Cell phone #
Other children in the family along with their ages:
Please submit a brief statement as to why you would like your child to attend Little Cane's Academy.
Person to contact and emergency telephone number (other than your own)
I give permission for my child to be photographed/videotaped.
Any allergies or pertinent information we should have about your child.
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