Day School Registration 2024-2025

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Child's full name

*

Child's full date of birth

*

Child's age on Aug 31, 2024 (This will determine their class.)

*

Please select one option.

1 2 3 4

Child's address

*

Person(s) your child lives with

*

Please select all that apply.

Mom Dad Mom and Dad Guardian Other

Mother/Guardian's name

Mother/Guardian's cell number

Mother/Guardian's email

Father/Guardian's name

Father/Guardian's cell number

Emergency Contact #1 with permission to pick up your child

*

Emergency Contact #1 cell number

*

Emergency Contact #1 Relationship to your child

*

Please select one option.

Grandparent Other Relative Friend Babysitter/Nanny

Emergency Contact #2 with permission to pick up your child

*

Emergency Contact #2 cell number

*

Emergency Contact #2 Relationship to your child

*

Please select one option.

Grandparent Other Relative Friend Babysitter/Nanny

Child's allergies

*

Symptoms of these allergies

Response required for allergic reactions

Health/medical conditions

*

Symptoms for these medical conditions

Response required for these health/medical conditions

Additional information you would like to share about your child

Description

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