Family Connect Registration

Family Connect Registration Form

Child's Name - First, Middle, Last

Gender:

Male

Female

School Attending:

Grade Level for 2024-2025:

Date of Birth:

Street Address:

City:

State:

Zip Code:

Child Lives with?

Mother and Father

Mother

Father

Legal Guardian

Primary Phone Number:

Primary Email:

Mother's Name:

Mother's Phone Number

Mother's Email Address

Father's Name

Father's Phone Number

Father's Email Address

Emergency Contact Person(Other than Parent)

Emergency Contact Phone Number:

If your child has any health issues, including allergies, or if your child is on regular medication or has special needs, please explain below. Also, if there are any custody issues of which we should be aware, please indicate below as well.

Family Connect Registration

Family Connect Registration Form

Contact Us

Mailing Address

Office Hours