Student's Name
*
First Name
Last Name
Student's Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's E-mail
example@example.com
May we send information about future events to the e-mail address provided above?
Yes
No
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
List of Allergies
If none, please submit "none"
($20) Payment Method :
*
Cash App - @leetonspto
Cash
Check
Add your student's name in the subject line of CashApp payments
Make all checks payable to "Leeton COPE"
Give all cash and checks to the Elementary Office or the student's teacher
Submit
Should be Empty: