Moonshot Families Registration

Moonshot Families Registration

A program of The Learning Alliance
Tell Us About the Students
Number of children age 5 years and under
Enter the number of children you will be submitting to The Learning Alliance.
Child 1 First Name
Child 1 Last Name
Child 1 Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child 1 Preschool
Child 1 Homeschool or Other details
Child 1 Kindergarten
Child 2 First Name
Child 2 Last Name
Child 2 Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child 2 Preschool
Child 2 Homeschool or Other details
Child 2 Kindergarten
Child 3 First Name
Child 3 Last Name
Child 3 Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child 3 Preschool
Child 3 Homeschool or Other details
Child 3 Kindergarten
Child 4 First Name
Child 4 Last Name
Child 4 Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child 4 Preschool
Child 4 Homeschool or Other details
Child 4 Kindergarten
Child 5 First Name
Child 5 Last Name
Child 5 Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child 5 Preschool
Child 5 Homeschool or Other details
Child 5 Kindergarten
Child 6 First Name
Child 6 Last Name
Child 6 Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child 6 Preschool
Child 6 Homeschool or Other details
Child 6 Kindergarten

Check all that apply. I use:
I give permission for photos or videos of my children and family at Moonshot Families events to be shared by The Learning Alliance to promote literacy on websites, social media, printed materials, Youtube, newspapers, etc
Should be Empty:

Tell Us About the Students