The Learning Tree Registration
Please note that our availability is on a first come , first serve basis. We will keep this form updated as accurately as possible but there may be some availability that is filled before we are able to update our form.  Thank you .

5 year olds- This class has limited space and is only available on Tuesday/Thursday.  
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Child's Name/Nickname
Requested Session
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Any additional comments or requests?
Child's Gender
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Child's Age (as of 8/15/2022)
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Child's Birthday
MM
/
DD
/
YYYY
Father's Information: name
Father's Personal Information: phone number, address
Father's Information: primary email
Father's Employer Information: employer, position and phone number
Mother's Name
Mother's Personal Information: phone, address
Mothers' Information: primary email
Mother's Employer Information: employer, position and phone number
Please list the names, ages, & schools of other children in your family/household.
Does your child have any health problems? If so, please explain.
Does your child have any seasonal or food allergies? If yes, please explain.
Does your child have any vision, hearing, or speech problems? If yes, please explain.
Does your child wear glasses? If yes, for what & how often?
Are there any medications given regularly to your child?  If so, what are they?
Child's Physician: name, office, phone #
Emergency Contact Information: Please list at least two other people (other than a spouse) who are authorized to pick up your child from school or act in your behalf in an emergency. We cannot release your child to anyone without your prior permission. (Be sure to include name, relationship, and  phone # for each person added)
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