First Name
Last Name
Address ?
Include your address, city, and zip
Phone Number
?
Example: 734-555-5555
Parents Email Address
Child's name
?
First, and last name.
Age of student with birthdate
?
Example: 6 years old 03/15/2009
Last Grade Completed
?
Enter a grade level, or If homeschooled please mention.
Medical Information and/or allergies
Emergency Contact ?
Names, Home, work, and Cell phone numbers
Dismissal Information
?
Who will be picking up your child.
Church Affiliation
?
Which church do you belong to?
Do you attend church?
If Yes, which Church do you attend?
Are you visiting?