School Registration Form

Date: ______________________

Family Information: We happily welcome all children. For safety reasons, all children must
have a registration form on file.
Parent Name:_________________________________ Home Phone:___________________
Parent Name: _________________________________ Cell Phone: ____________________
Address:____________________________________________________________________
Email:_____________________________________________

Student Information: Students grade two and under must have listed the people authorized
to pick them up.
Child’s Name:__________________________________ Grade in September:______
Date of Birth: __________________________ Age, as of September 1, 2021: ______
Special Info (food allergies, etc.)
_____________________________________________________________________
Person(s) authorized to pick up child _ _____________________________________

Child’s Name:__________________________________ Grade in September:______

Date of Birth: __________________________ Age, as of September 1, 2021: ______
Special Info (food allergies, etc.)
_____________________________________________________________________
Person(s) authorized to pick up child _ _____________________________________

Signature :