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Student Information
Please help me get to know you and your family by completing the questions below!
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* Indicates required question
Child's Name: (First, Middle, Last)
*
Your answer
Child's Age:
*
Your answer
Child's Birthday (month, day, year)
*
MM
/
DD
/
YYYY
Primary Phone Number (BEST way to contact you during the day)
Your answer
Child's Mailing Address (street, city, zip code)
*
Your answer
Primary E-mail Address
*
Your answer
Child Lives With:
*
Mother
Father
Both
Other:
Please list any allergies or other medical conditions that I need to be aware of for your child:
*
Your answer
Please list any holidays or other celebrations that your child cannot take part in:
Your answer
Child's Morning Transportation:
*
Car Rider
Bus Rider
Extended Care
Required
If your child is a bus rider in the morning, please list bus number;
Your answer
Child's Afternoon Transportation:
*
Car Rider
Bus Rider
Extended Care
Required
If your child is a bus rider in the afternoon, please list bus number;
Your answer
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