TULIP 2019-2020 Registration Form
Monday - Friday: 2:30-6:00 -- Follows City Schools of Decatur schedule
Address: 2840 Franklin Street, Suite F, Avondale Estates, GA 30002
Contact us at (404) 444-9815 or atlTULIP@gmail.com
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メールアドレス *
Welcome!
Parent/Guardian Information
Please list ALL parents, guardians, and/or caregivers below
Parent/Guardian #1: Name *
Parent/Guardian #1: Relationship (i.e. mother, father, grandmother, guardian, etc.) *
Address *
Cell Phone *
Home, work, or alternative phone (optional)
Parent/Guardian #2: Name
Parent/Guardian #2: Relationship (i.e. mother, father, grandmother, guardian, etc.)
Address
Cell Phone
Home, work, or alternative phone (optional)
Additional email address (if different than above):
Name of additional parent/guardian/caregiver not listed above (if needed):
Relationship of additional parent/guardian (i.e. mother, father, grandmother, guardian, sitter, etc.)
Emergency Contact:
Please provide a contact that is NOT already listed.
Emergency Contact NAME (not already listed) *
Emergency Contact PHONE (not already listed) *
Student ONE Information
Student ONE Name: *
Student ONE Date of Birth *
Student ONE Grade for 2019-2020: *
Student ONE School (attending 2019-2020): *
What days are you interested in student ONE attending? *
Drop-in days preferred:
TRANSPORTATION: Will Student ONE utilize transportation from their CSD school? *
必須
Student ONE Allergies: (please list all below or none) *
Student ONE: please list any medical/physical challenges or special care that you know the student may require: (PLEASE NOTE: TULIP is not equipped for all special needs. If your child has special needs, please contact us at atlTULIP@gmail.com to inquire if we can accommodate.) **n/a if not applicable** *
Student TWO Information
Student TWO Name:
Student TWO Date of Birth
Student TWO Grade for 2019-2020:
Student TWO School (attending 2019-2020):
What days are you interested in student TWO attending?
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Drop-in days preferred:
TRANSPORTATION: Will Student TWO utilize transportation from their CSD school?
Student TWO Allergies: (please list all below or none)
Student TWO: please list any medical/physical challenges or special care that you know the student may require: (PLEASE NOTE: TULIP is not equipped for all special needs. If your child has special needs, please contact us at atlTULIP@gmail.com to inquire if we can accommodate.) **n/a if not applicable**
Student Pick-up/Release Approval List:
Please list any adults allowed to pick-up students (other than parents listed) below
List here or n/a: *
Is there anything else you'd like us to know?
I understand that this form does not guarantee enrollment. *
必須
I understand that should student be accepted into the program, additional signed forms are required. (i.e. Medical release, transportation form, photo release, handbook acceptance, etc.) *
必須
I understand that TULIP is an enrichment program and is exempted from licensure. (enter name below) *
I understand that TULIP carries limited liability insurance. (enter name below) *
All tuition and fees will be billed to the email address above. Registration will not be considered until fees are paid.
Thank you!
送信
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