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* 1. Child's full name (as listed on birth certificate)

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* 2. Child's date of birth

Date

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* 3. What is your child's gender?

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* 4. Child's Physical Address

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* 5. What is your home district?

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* 6. Will your child attend:

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* 7. Parent/Guardian Name (person enrolling the child)

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* 8. Parent/Guardin phone number where you can be reached
please include area code

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* 9. Parent/Guardian email address

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* 10. Parent/Guardian physical address

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