Full Name

Parent or Guardian

Relationship to Child

Email *

Phone *

Address

Street Address

City

State

Country

Postal code

Is your child a new or returning student?

New Student

Returning Student

Child's Name

Preferred Name/Nickname

Child's Gender

Child Date of Birth

Age

School

Current Grade and Teacher

T-Shirt Size

Hoodie Size (Distributed in late November)

Favorite Meal

Favorite Drink

Favorite Snack

What does your child like to do in their free time?

How does your child do in school? Will they need help with homework?

What do you do that makes your child feel most loved?

What type of discipline works best for your child?

Who lives in the home with the child?

Does your child have any health issues? (Allergies, Asthma, ADHD, Diabetes, Epilepsy, etc.) If so, please explain. Is there anything we should look for? (NOTE: We are NOT a peanut-free facility)

Does your child have any diet restrictions?

Does your child have any special needs? If so, please explain. **Due to the nature of our program and the availability of our volunteers, we will not be able to accommodate children who require one-on-one attention, unless they have an accompanying adult. All questions can be directed to Jen at 254-913-1953.

Do you have another child to register?

Yes

Child 2 Name

Child 2 Preferred Name/Nickname

Child 2 Gender

Child 2 Date of Birth

Child 2 Age

Child 2 School

Child 2 Current Grade and Teacher

Child 2 T-Shirt Size

Child 2 Hoodie Size

(Distributed in late November)

Child 2 Favorite Meal

Child 2 Favorite Drink

Child 2 Favorite Snack

What does child 2 like to do in their free time?

How does your child 2 do in school? Will they need help with homework?

What do you do that makes your child 2 feel most loved?

What type of discipline works best for your child 2?

Who lives in the home with child 2?

Child 2 - Does your child have any health issues? (Allergies, Asthma, ADHD, Diabetes, Epilepsy, etc.) If so, please explain. Is there anything we should look for? (NOTE: We are NOT a peanut-free facility)

Child 2 - Does your child have any diet restrictions?

Child 2 - Does your child have any special needs? If so, please explain. **Due to the nature of our program and the availability of our volunteers, we will not be able to accommodate children who require one-on-one attention, unless they have an accompanying adult. All questions can be directed to Jen at 254-913-1953.

Additional Contact Name

Additional Contact Phone Number

Additional Contact Relationship to Child

Are they authorized to pick up child?

Yes