1. Parent information Father's info* Fathers First Name Fathers Last Name Cell Phone* Area Code Phone Number Work Phone Area Code Phone Number E-mail* Mother's info* Mothers First Name Mothers Last Name Cell Phone* Area Code Phone Number Work Phone Area Code Phone Number E-mail* Primary email 2. Child's Information Child 1* First Name Middle Name Last Name Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender* MaleFemale Grade Entering August 2024* 2 Yrs 3 Yrs 4 Yrs 5 Yrs 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade School Currently Attending * * Full Summer ( June 25 - August 8)Week 1 (June 25 - June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15 - July 19)Week 5 (July 22 - July 26)Week 6 (July 29 - August 2)Week 7 (August 5 - August 8) Child 2 First Name Middle Name Last Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender MaleFemale Grade Entering August 2024 2 Yrs 3 Yrs 4 Yrs 5 Yrs 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade School Currently Attending Full Summer ( June 25 - August 8)Week 1 (June 25 - June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15 - July 19)Week 5 (July 22 - July 26)Week 6 (July 29 - August 2)Week 7 (August 5 - August 8) Child 3 First Name Middle Name Last Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender MaleFemale Grade Entering August 2024 2 Yrs 3 Yrs 4 Yrs 5 Yrs 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade School Currently Attending Full Summer ( June 25 - August 8)Week 1 (June 25 - June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15 - July 19)Week 5 (July 22 - July 26)Week 6 (July 29 - August 2)Week 7 (August 5 - August 8) Child 4 First Name Middle Name Last Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender MaleFemale School Currently Attending Grade Entering August 2024 2 Yrs 3 Yrs 4 Yrs 5 Yrs 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade Full Summer ( June 25 - August 8)Week 1 (June 25 - June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15 - July 19)Week 5 (July 22 - July 26)Week 6 (July 29 - August 2)Week 7 (August 5 - August 8) Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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