Child's Name *

First Name

Last Name

Gender *

Male

Female

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Parent's Name

First Name

Last Name

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Legal Guardian, if not listed above

First Name

Last Name

Meadow park Church member *

Yes

No

Kindergarten Program

Before and After Morning Kindergarten

After Morning Kindergarten only

Grades 1st-5th

Before only

Before and After

After only

School Holiday

Sumer Program (K-5th Grade)