Child’s Full Name
*
First Name
Last Name
Child’s Date of Birth
*
-
Month
-
Day
Year
Date
Grade (as of Fall 2026)
*
Please Select
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Other
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical or Allergy Information
Authorized Pickup Persons (other than parent/guardian)
Photo/Media Release Consent
*
Yes, I give permission
No, I do not give permission
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