GRACEKIDS / KIDSCUB REGISTRATION 2020-2021
Today's Date
/
Month
/
Day
Year
Date
Parent or Guardian (If Parent/Guardian is not here, name of Adult who brought the child, and relationship to child)
*
Parent/Guardian/Accompanying Adult Email Address(es)
*
example@example.com
Best contact while the child is in class
*
Parent cell phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CHILD 1
Name
*
Gender
Please Select
M
F
Child 1 birth date
-
Month
-
Day
Year
Date
Age
*
Grade
*
Allergies / Reaction
*
Any other information about your child that may be helpful to the caregivers/teaching team?
Does your child receive any therapeutic services or have an IEP or 504 plan?
*
Yes
No
CHILD 2
Name
Gender
Please Select
M
F
Child 2 Birth Date
-
Month
-
Day
Year
Date
Age
Grade
Allergies / Reaction?
Any other information about your child that may be helpful to the caregivers/teaching team?
Does your child receive any therapeutic services or have an IEP or 504 plan?
Yes
No
CHILD 3
Name
Gender
Please Select
M
F
Child's birth date
-
Month
-
Day
Year
Date
Age
Grade
Allergies / Reactions?
Any other information about your child that may be helpful to the caregivers/teaching team?
Does your child receive any therapeutic services or have an IEP or 504 plan?
Yes
No
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