Registration Form

2021 - 2022 Registration Form

 

Child’s Name and age:

Nickname:

Name you would prefer they practice writing:

Date of Birth:

Mother’s name:

Father’s name:

 

Mother

 

Phone number:

Address:

Email address:

 

Father

 

Phone number:

Address:

Email address:

 

Emergency Contact Number:

Relationship to student:

 

Does your child have any allergies? If so please list them:

 

 

About your student

 

Favorite food:

Favorite color:

Favorite movie or TV show:

Favorite activity: 

 

Anything else I should know about your child?

Once your child's registration form is submitted and the $40 registration fee is paid, your child's spot will be held! Forms can be sent to getupandmoveprek@gmail.com and the fee can be paid through Venmo (@courthansen).