Moonshot Families Registration

Moonshot Families Registration

A program of The Learning Alliance
Tell Us About the Students
Number of Children*
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
Date
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
Date
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
Date
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
Date
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
Date
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
Date
Child 6 Preschool*
Child 6 Homeschool or Other details*
Child 6 Kindergarten

Check all that apply. I use:

FacebookInstagramYouTubeTikTokTwitter
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*

YesNo
Should be Empty:

Tell Us About the Students