FLF-registration-page-001

Online FLF Registration Form

Email Address: (required)

Child's Name (required)

Date of Birth

Gender

Please list allergies

Name you would like your child to learn to write & be called

Street Address

City/Zip

Mother's Name

Home/Cell

Work

Father's Name

Home/Cell

Work

Sibling's Name/Age

List any person, in addition to parents, who is allowed to pick-up your child if there are special circumstances, please list:

Name

Phone



Is your child receiving any special services? Example: Speech, Occupational Therapy, Emotional Support or English as a second language:

What agency is your child receiving these services through:

Clearances: Any parent/guardian/person who plans to volunteer in the classroom must have their
Criminal and Child Abuse clearances. These forms are available in the Park office. If you do have
your clearances, please check the box below and submit a copy to the office.

 Criminal Clearances Child Abuse FBI