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Parent Registration Form
Date: _________________________
Name of parent(s)
____________________________________________________
Address ____________________________________________________
Phone # home______________ work ________________
cell ___________________ Email_____________________________________________
Name of child #1 _____________________________ Birth date _________________
Name of child #2 _____________________________ Birth date _________________
Name of child #3 _____________________________ Birth date _________________
Desired start date ____________________________
Special needs/interests of child_____________________________________________
License Number: ________________________________________________________
Start Date: _______________________________________________
Language:
Bilingual – English & Spanish
Spanish