SUMMER PRE-ENROLLMENT FORM

SUMMER PRE-ENROLLMENT FORM
Child's Legal Name
Child's Birthday

MonthDayYear
Date
Child's Age
Child's Allergies
Child's Gender Identity
Child's current elementary school
Child's current teacher
Child's Grade in School
Child's legal guardian
Mother's Name
Cell Phone
Format: (000) 000-0000.
Home Address
Email Address
example@example.com
Father's Name
Cell Phone
Format: (000) 000-0000.
Home Address
Email Address
example@example.com
What is the household income?
What academic areas does your child need help in?
What language do you speak most often to your child?
Does your child speak and understand English? Y/N
Who will drop off and pick up your child?
Does your child have a library card?
Are the parents of the child vaccinated?
Is the child vaccinated?
Do you agree that we may sanitize your child's hands regularly?
Signature
Should be Empty: