Enrichment Family Information Form – Mobile

Registration Form

2. You do not need to complete the Family Information Form If you have signed up in the past and no information has changed.

Children

Number of children attending Highline Academy

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Child's Name

First Last

Date of birth

Age

Any allergies or medical alerts

Yes
No

If yes, please explain

Homeroom teacher

Where will student go after the program?

Parents / Guardian will pick up
Go to Kids Adventures
Other

If other, please explain

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Child's Name

First Last

Date of birth

Age

Any allergies or medical alerts

Yes
No

If yes, please explain

Homeroom teacher

Where will student go after the program?

Parents / Guardian will pick up
Go to Kids Adventures
Other

If other, please explain

[hr]

Child's Name

First Last

Date of birth

Age

Any allergies or medical alerts

Yes
No

If yes, please explain

Homeroom teacher

Where will student go after the program?

Parents / Guardian will pick up
Go to Kids Adventures
Other

If other, please explain

[hr]

Child's Name

First Last

Date of birth

Age

Any allergies or medical alerts

Yes
No

If yes, please explain

Homeroom teacher

Where will student go after the program?

Parents / Guardian will pick up
Go to Kids Adventures
Other

If other, please explain

[hr]

Child's Name

First Last

Date of birth

Age

Any allergies or medical alerts

Yes
No

If yes, please explain

Homeroom teacher

Where will student go after the program?

Parents / Guardian will pick up
Go to Kids Adventures
Other

If other, please explain

[hr]

Child's Name

First Last

Date of birth

Age

Any allergies or medical alerts

Yes
No

If yes, please explain

Homeroom teacher

Where will student go after the program?

Parents / Guardian will pick up
Go to Kids Adventures
Other

If other, please explain

[hr]

Parents and Guardians

Guardian 1 Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Cell Phone

Other Number

Email

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Guardian 2 Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Cell Phone

Other Number

Email