Cascade Learning Co
Kindergarten Prep Academy
CHILD INFORMATION:
Child Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
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Month
Please select a day
1
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Day
Please select a year
2026
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Year
Select Session
*
July 7-10
July 21 - 24
August 4 - 7
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
MEDICAL INFORMATION
Physician Name
*
First Name
Last Name
Phone Number
*
Medical Concerns
*
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Name and phone number(s) of person(s) other than guardian allowed to pick student up:
*
Please tell us any other information you would like us to know about your student:
*
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We would be grateful if you would fill in this form to give us permission to take photos of your child and use these in our printed and online publicity. I give Cascade Learning Co permission to take photographs and/or video of my child. I grant Cascade Learning Co full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity, or other purposes to help achieve the aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases, and funding applications.
*
I agree and give consent
I do not agree and do not give consent
Signature
*
My Products
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Kindergarten Prep Academy
$
250.00
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