REGISTRATION FORM

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Bringing literacy to life through engaging stories, education, and creativity.
REGISTRATION FORM
(Please Print) Studen's Name
Student's Address
City
State
Zip Code
DOB
Grade
School & Principal
Parent/Guardian's Name
Parent/Guardian's Address
City
State
Zip Code
Home Phone
Cell Phone
Email Address
example@example.com
Emergency Contact Person(s), Phone Number(s) and Relationship
Student Number
By ticking the circle, I consent to my child to be placed on the Prindle House social media page.

Tick here
Should be Empty: