Community Engagement Registration

Child # 1 *

You may enter two children at separate schools on the same form.

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Child # 2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Parent/Guardian #1 *

First Name

Last Name

Phone *

(###)

###

####

Parent/Guardian #2

First Name

Last Name

Phone

(###)

###

####

Payment Type - Payment information will be entered in Step 2 *

All payments are due on or before the 1st of the month. Late payments will be charged a $10.00 late fee.

Credit Card

Check