New Child Registration

Please fill out this form and click submit.

Name

*

Birthdate

*

Grade

*

Please select one option.

Nursery (Under 18 months) Toddlers (18 months-2 Years) Preschool (4 years) Preschool (4 years) Pre-K Kindergarten 1st 2nd 3rd 4th 5th

Parent's Name

*

Parent Cell Phone

*

Allergies?

*

Please select one option.

Yes No

If yes, what kind?

Special information/concerns to help us better minister to your child? (I.e. health diagnosis, comorbidities, actions that help calm them down, etc.):

*

Parent Email

*

This address will receive a confirmation email

Extra Parent Email

*

This address will receive a confirmation email

Address

*

Description

Please fill out this form and click submit.

Please Fix the Following

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