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Enrollment form
ENROLLMENT FORM
ENROLLMENT FORM
CHILD INFORMATION:
Child’s Name:
Date of Birth:
Home Address:
Sex:
Primary Language:
Telephone:
Height:
Weight:
Eye Color:
Skin Color:
Identifying Marks:
Allergies/Special Diets:
PARENT/GUARDIAN INFORMATION:
ENTER PARENT/GUARDIAN INFORMATION
Parent/Guardian Name:
Relationship to Child:
Home Address:
Email
Bus. Name:
Bus. Address:
Telephone #:
Hours at Work:
ADD PARENT/GUARDIAN
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ADDITIONAL INFORMATION:
Child’s Physician/Clinic:
Telephone #:
Chronic Health Conditions:
Special Limitations or Concerns:
If you are human, leave this field blank.
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Enrollment form