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Gearing Up for Kindergarten Registration Form

Gearing Up for Kindergarten

Registration

 

Parent(s) Name(s): _______________________________________

 

Address: _______________________________

 

City: _____________________________

 

State: _______________ Zip: _________

 

Phone: ____________________________

 

Alternate Phone: ____________________

 

E-mail: ____________________________

 

Child’s Name: ______________________

 

Birthdate: __________________________

 

School:  ___ Washington    ___ Five Points

 

Do you need child care for siblings?

____ yes                              ____ no

 

If yes, please list the names and ages of  the children:

___________________________________

___________________________________

 

Does anyone have any allergies or medical conditions that we need to be aware of?

____ yes                         ____ no

 

If yes, please specify.

_____________________________________

_____________________________________

 

Please return completed registration form to:

Rae Temples

363 Five Points Richmond Road

Bangor, Pa 18013

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