Parent/Guardian 1 Parent/Guardian Name * First Name Last Name Relationship to Child * Date Of Birth * MM DD YYYY Parent/Guardian 2 Spouse/Guardian Name First Name Last Name Relationship to Child Attendance Type * Regular Attender Visitor Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Child 1 Child's Name * First Name Last Name Goes by (if different than name listed above) First Name Last Name Date of Birth * MM DD YYYY Current Grade * If not applicable, please select N/A N/A Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th Gender * Boy Girl Allergies / Health Concerns Child 2 If Applicable Child's Name First Name Last Name Goes by (if different than name listed above) First Name Last Name Date of Birth MM DD YYYY Current Grade If not applicable, please select N/A N/A Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th Gender Boy Girl Allergies / Health Concerns Child 3 If Applicable Child's Name First Name Last Name Goes by (if different than name listed above) First Name Last Name Date of Birth MM DD YYYY Current Grade If not applicable, please select N/A N/A Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th Gender Boy Girl Allergies / Health Concerns Child 4 If Applicable Child's Name First Name Last Name Goes by (if different than name listed above) First Name Last Name Date of Birth MM DD YYYY Current Grade If not applicable, please select N/A N/A Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th Gender Boy Girl Allergies / Health Concerns Thank you!Welcome to LifeKids!
