Student #2 Grade Completed for 2023-2024 School Year
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Student #3 Name (Last, First)
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Student #3 Grade Completed for 2023-2024 School Year
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Student #4 Name (Last, First)
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Student #4 Grade Completed for 2023-2024 School Year
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Parent/Guardian Name *
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Address *
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Parent/Guardian Phone Number *
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Parent/Guardian Email Address *
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Who is allowed to pick up your student(s) each day? *
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Is there anyone who is NOT allowed to pick up your student(s) each day?
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Does your student have any allergies or medical concerns we should be aware of? If you have included multiple students above, please indicate which student has the listed medical condition.
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If you also have students who are 3-4 years old (have not attended 5-K yet), please include their names and ages below. We have a preschool class available for siblings of older students and children of workers.