Defenders of Life Enrichment
2024-2025
There is no cost to join the Defenders of Life enrichment program.
Parent/Guardian Name
*
Date
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email address
*
example@example.com
Student 1 Name
*
First Name
Last Name
Class
*
Please Select
KS
KW
1KM
1M
2B
2F
3B
3M
4B
4T
5A
5B
6A
6B
7
8
Student 2 Name
First Name
Last Name
Class
Please Select
KS
KW
1KM
1M
2B
2F
3B
3M
4B
4T
5A
5B
6A
6B
7
8
Student 3 Name
First Name
Last Name
Class
Please Select
KS
KW
1KM
1M
2B
2F
3B
3M
4B
4T
5A
5B
6A
6B
7
8
Allergies, medical concerns, or other information about your child we may need to know (if registering multiple children, specify child with information):
Transportation - after the enrichment class my child(ren) will be
*
Picked up by parent or guardian
Attending Kids Club
Other
Signature
*
Submit
Should be Empty: