Parent/Guardian Information *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Child Name *

First Name

Last Name

What grade will your child be in this coming fall semester? *

Pre-K

Kindergarten

1st

2nd

3rd

4th

5th

What week(s) are you enrolling your child in? *

3 week minimum required.

Everything Edible Week (June 2-6)

Water Week (June 9-13)

A Week Around The World (June 16-20)

Physics Week (June 23-27)

All About America Week (June 30-July 3rd)

STEM Week (July 7-11)

Is child prescribed an inhaler or medication? *

Yes

No

Photo Release?

Yes

No

Emergency Contact *

First Name

Last Name

Phone *

(###)

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