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  • Ms. Boedee's Kinder Prep 2014-2015 Registration Form: - Date Paid Check #

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    Boedee Gruwell Reed
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    Registration Form

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    Registration Form

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    Registration Form

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    31 views1 page

    Ms. Boedee's Kinder Prep 2014-2015 Registration Form: - Date Paid Check #

    Uploaded by

    Boedee Gruwell Reed
    Registration Form

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    ___Date Paid

    Check #

    Ms. Boedees Kinder Prep


    2014-2015
    Registration Form
    A one-time registration fee of $25 is due at the time of registration.

    Childs Name_________________________________Name They Go By in School_______________________


    Birthday____________________________
    Mothers Name__________________________

    Fathers Name_____________________________________

    Home Address______________________________________________________________________________
    Home Phone___________________________

    Mothers Cell_______________________________________

    Fathers Cell____________________________ Email Address_______________________________________


    Emergency Contact Person(s)
    Name________________________________________________ Phone______________________________
    Name________________________________________________ Phone______________________________
    Authorized Person(s) Who May Pick Up After School
    Name_________________________________________________Phone_______________________________
    Name_________________________________________________Phone_______________________________
    Please list any allergies to medications, foods, or other substances, etc.
    __________________________________________________________________________________________
    Is there any food that your child wont eat for snack?______________________________________________
    I agree that the operator may authorize the physician of his/her choice to provide emergency medical care in
    the event that neither I, my spouse, alternate contact(s), can be located immediately.
    Parents Signature_______________________________________ Date_______________________________
    Operators Signature_____________________________________ Date_______________________________

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