Registration 2023-24

Child’s Name:

First

Middle

Last

Age:

Sex

Boy

Girl

Date of Birth:

Child’s primary language

Child’s home address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Has your child ever attended a care center or another school?

Yes

School / Center’s name

List family members your child lives with – include first names, relation and ages of siblings

Parent/guardian full name:

First

Last

Relationship to child

Cell phone

Home address if different to child’s

Yes

Address

Street Address

City

State / Province / Region

ZIP / Postal Code

Country

Race

Marital Status

Occupation

Work phone

Work hours

Currently employed?

Yes

Employer

Employer address

Street Address

City

State / Province / Region

ZIP / Postal Code

Country

Parent Signature: