Curious Kids Club
with Mrs Houpt & Mrs Simonds
Student Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Student Grade Level:
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Homeroom Teacher:
*
Puppy Club (choose 1 date):
*
February 25th (Tuesday)
February 27th (Thursday)
I give my child permission to pet the puppy:
*
Yes
No
Total:
Payment
*
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next
( X )
USD
$3.50 connivence fee has been added
Credit Card
Please verify
*
Submit
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