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K-2 SMARTe Micro-School Online Enrollment Form
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* Indicates required question
Child's Name:
*
Your answer
Gender:
*
Female
Male
Prefer not to say
Other:
Address:
*
Your answer
DOB:
*
MM
/
DD
/
YYYY
Grade:
*
Your answer
ZIP:
*
Your answer
Mother/Guardian Name:
Your answer
Address (If different:)
Your answer
Home Phone:
Your answer
Cell Phone:
*
Your answer
Email:
Your answer
Father/Guardian Name:
Your answer
Address (if different):
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Home Phone:
Your answer
E-mail:
Your answer
Who is the child living with?
*
Mother
Father
Both:
Other:
Who check out the child from the program? (You can select multiple)
*
Mother:
Father:
Legal Guardian:
Emergency Contact:
Emergency Contact If Parents Cannot Be Reached:
Name:
*
Your answer
Relation to child:
*
Your answer
Work phone:
*
Your answer
Home phone:
*
Your answer
Cell phone:
*
Your answer
What Timezone Are You In?
*
Your answer
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