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2024 – 2025 Registration Form
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2024 – 2025 Registration Form
2024 – 2025 Registration Form
ManhattenKids
2024-09-03T15:56:03+00:00
Student's Name
(Required)
Age
(Required)
Student's School
(Required)
Grade
(Required)
Classroom #
(Required)
Home Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone #
(Required)
Mother's Name
(Required)
Tele (Day)
(Required)
Email
(Required)
Cell #
(Required)
Mother's Firm and Address
(Required)
Father's Name
(Required)
Tele (Day)
(Required)
Tele (Eve)
(Required)
Email
(Required)
Cell #
(Required)
Father's Firm and Address
(Required)
Allergies or Special Medical Conditions:
(Required)
Emergency Contacts and Phone #'s
(Required)
Out of State Contact
(Required)
Pediatrician's Name
(Required)
Pediatrician's Phone #
(Required)
Note: There are no refunds or make-ups for absences.
Date
(Required)
MM slash DD slash YYYY
Relation to Child
(Required)
(Required)
By submitting this form, I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that submission of this form serves as my digital signature and that it indicates my acceptance of these terms.
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