** WAITLIST **                                                                                                    Lehi Rippy Literacy Center Morning ABC Program Winter/Spring Registration 2023
Eligible students must be 4 years old by September 1, 2022.
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Child's First Name(and what you want on their name tag)

 *
Child's Last Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Child's Gender *
Parent's Name *
Parent's Home Address (MUST be a Lehi City resident) *
Parent's Email *
Parent's Phone Number *
Emergency Contact Name & Phone Number *
Out of Area (Utah County) Name & Phone Number *
Medical Issues for Child *
Media Waiver: I understand that the Literacy Center PARTICIPANTS MAY BE PHOTOGRAPHED at various activities to advertise/promote our services and the center.  Photos may be posted at the Literacy Center or on our social media sites.  I agree to allow any photo, video or film likeness of me or of my minor child(ren) to be used for legitimate purposes by the event holders, producer, sponsors, organizers, and or assigns. *
Required
Parent Signature: By signing electronically you are verifying that all of the information above is true and accurate. This also confirms your preference for the Media Waiver statement above. *
Specify Day and Time Requested *
Required
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