TEA Registration Form

Family Information
Parent/Guardian Name*

PrefixFirst NameLast NameSuffix
Preferred Phone*
Preferred E-mail*
Parent/Guardian Name

PrefixFirst NameLast NameSuffix
Preferred Phone
Preferred E-mail
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact

Person(s), other than parents/guardians, authorized to pick up child(ren)
Emergency Contact 1

PrefixFirst NameLast NameSuffix
Gender

MaleFemale
Relation to Child(ren):
Phone
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact 2

PrefixFirst NameLast NameSuffix
Gender

MaleFemale
Relation to Child(ren):
Phone
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code

Child 4 Information
Name*

First NameMiddle NameLast Name
DOB*

MonthDayYear
Date
Gender:*
Age*
Current School:*
Grade in the Fall:*
Primary Language Spoken at Home
Please list any food allergies or other exceptional circumstances that we should be aware of:
For reporting purposes, please select the following option(s) that best describes your child's race/ethnicity.

American Indian / AlaskianBlack / African AmericanAsianPacific IslanderHispanic / LatinoWhite / CaucasianMulti-RacialOther
If you wish to enroll more than 4 children at TEA, please complete this form for the first four and complete an additional application as necessary.

HEALTH EXAMINATION FORM

Complete and Upload (Required for Enrollment)
Health Examination Form*

Browse Files
Must complete a form for each child. Cancelof
Acknowledgment
I hereby acknowledge that the aforementioned application has been completed in its entirety with clear and accurate information, and I understand that it is imperative for me to submit all requisite forms prior to the official review of my application.*
Parent(s)/Guardian(s)
Signature*

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Parent(s)/Guardian(s)
Submission Date*

MonthDayYear
Date

TEA Enrollment Application