Weekend School Enrollment Form

Weekend School Enrollment Form
CHILD INFORMATION:
1. Child Name
First NameLast Name
2. Child Name
First NameLast Name
3. Child Name
First NameLast Name
1. Birth Date
MonthDayYear
2. Birth Date
MonthDayYear
3. Birth Date
MonthDayYear
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Post Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
MEDICAL INFORMATION
Please mark in this box to give us permission to take photos of your child and use these in our printed and online publicity.
Please indicate your child's food allergies and special needs below
Scholarship
I understand that by signing below I acknowledge and agree to the above statements.
Signature
Clear
Should be Empty: