Student Registration Form - Summer 2024
Please use this Google Form to begin your Registration paperwork.
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Email *
Please select your Summer Program for your student *
Child's First Name *
Child's Last Name *
Child's Nickname
Date of Birth *
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DD
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Sex *
Physical Address (full address including City, State & Zip Code please) *
Home Phone *
Chronic Physical Problems/Pertinent Development Information/Special Accommodations Needed *
Current School *
Previous Daycare or School Attended *
If child attends this Center and another program, give name of program. *
Grade child will attend in 2024-25 Academic Year (next school year) *
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