Child'Name
Sex
DOB
Home Address
Home Phone or Main Phone Number
Eye color
Hair Color
Race
Height
Weight
Primary Language
Parent/Guardian Name
Relationship to Child
Cell Phone Number
Email Address
Email address
Preferred Contact Person / Number in Case of an Emergency
Names & Ages of other children in family
Allergies/Special Diets
Special Limitations or Concerns
Chronic Health Conditions
Are there any custody agreements, court orders and/or restraining orders pertaining to the child? If yes, where is the child’s primary residence?
Location (Please select a location you would like to attend)
Program (Please select a program you would like to register for)
Select any other subject of interest for tutoring and future class interest:
Other
Throughout the school year, there are many events/activities that we will want to record. Photographs will be taken often, and videos occasionally. These photographs will be used for classroom and hallway displays, art projects, blogs, or for memory books.
For the health and safety of each child at School, an allergy/medical concerns list is posted in the classroom. I authorize the School to include my child s name and relevant information on this list.
