This is an ATI EZForm. Fill out the form below then press submit. The information you enter will be placed into an Adobe PDF file that you can print, sign, and submit to the school office.
Child Information
Child's Name:
Date of Birth (MM/DD/YYYY): Male: Female:
Parent Information
Mother's Name:
Please provide at least one parent name (first and last) and at least two telephone numbers for each parent listed. 		Phone Home:
Phone Work:
Cell Phone:
Father's Name:
 Phone Home:
Phone Work:
Cell Phone:
Street Address:
City: State: Zip:
Email:
Schedule Information
Please specify date you would like your child to begin attendance (MM/DD/YYYY):
Schedule requested:
Check days required:
Half Day
3/4 Day
Full Day 		Monday
Tuesday
Wednesday
Thursday
Friday
  (three day choice may not be consecutive days)