Registration for: * 3k 3k plus asc 4k 4k plus asc asc only
Nickname/name he or she should learn to write:
Birthdate * MM 1 2 3 4 5 6 7 8 9 10 11 12 / DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / YYYY 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Child lives with:
Who will normally drop off your child? *
Who will normally pick up your child? *
Below, please list everyone who currently lives in your child’s household, including siblings, grandparents, step-parents, family friends, etc.:
Additional sibling(s) NOT living in the home:
Church Home:
School/Child Care Center Last Attended:
What are some of your child’s favorite activities?:
Activities your family enjoys together:
What is your child’s favorite color?
What is your child’s favorite animal?
Please list any additional information that you feel would be helpful for the teachers to know about your child (favorite books, special toys, fears, etc.).
Do you have any special talents or interests that you would be willing to share with your child’s class?
What do you hope your child will accomplish this year at Foundations?
How did you hear about Foundations?
Mother's Employer
Mother's Employer's Phone
Father's Employer
Father's Employer's Phone
List other telephone numbers such as beepers, cell phones etc
Instructions regarding how parent/guardian may be reached in an emergency
Doctor's Phone
Contact One Phone
Contact Two Phone
Contact Three Phone
Relationship to Child
Phone-Home
Phone-Work
Phone-Cell
Home Email *
Work Email
Relationship to Child
Phone-Home
Phone-Work
Phone-Cell
Home Email
Work Email
Relationship to Child
Phone-Home
Phone-Work
Phone-Cell
Relationship to Child
Phone-Home
Phone-Work
Phone-Cell
Relationship to Child
Phone-Home
Phone-Work
Phone-Cell
Does your child have any known allergies? If so, please list and describe symptoms/reactions and if your child uses an Epi-pen.
Other medical issues:
Please explain items checked (i.e. “wears glasses” or “tubes in ears” or “uses an inhaler”)
What is your child’s typical bedtime? *
Rising Time? *