Registration Form for First Time Families Preschool and Elementary

Name

*

Email

*

This address will receive a confirmation email

Your relationship to the child(ren)

*

If anyone else is permitted to pick-up, please list their names here.

*

Mobile Phone

*

Address

*

Name of First Child

*

Age

*

Grade (if applicable)

Any allergies or special conditions?

Name of Second Child

Age

Grade (if applicable)

Any allergies or special conditions?

Name of Third Child

Age

Grade (if applicable)

Any allergies or special conditions?

Name of Fourth Child

Age

Grade (if applicable)

Any allergies or special conditions?

Name of Fifth Child

Age

Grade (if applicable)

Any allergies or special conditions?

For safety purposes, I understand I must present the security claim tag assigned to me or a valid photo ID in order to obtain my child(ren) from ROCC KidzROCC environment(s) once they are checked in.

*

Yes

Description

Please fill out this form and click submit.