Registration / Enrollment
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COMPLETE ENROLLMENT APPLICATION
Child's Information: Full Name, Age and Birthdate
Mother / Guardian Name, Address, Phone Number
Mother / Guardian's Email Address:
Father / Guardian's Full Name, Address and Phone Number:
Father's Email Address:
Marital Status: Check One
If divorced are there any custody issues?
If Yes, Explain __________________________________
Food Allergies: Please list any food or liquids your child is allergic to:
Signing Child In and Out and Emergency Contacts: List names of person 18 and older authorized to pick up your child and call in case of any emergency. Please include address, phone number and relationship.
Date of Submission
Pay your Registration / Enrollment Fee Here by clicking the Donate Button