Co-op Registration

Parent/Guardian #1

Phone

Parent/Guardian #2

Phone

Address

Child #1 Name

Child #1 Birthday

Child #1 Grade

Child #1 - Allergies or other needs

Child #2 Name

Child #2 Birthday

Child #2 Grade

Child #2 - Allergies or other needs

Child #3 Name

Child #3 Birthday

Child #3 Grade

Child #3 - Allergies or other needs

Child #4 Name

Child #4 Birthday

Child #4 Grade

Child #4 - Allergies or other needs

Child #5 Name

Child #5 Birthday

Child #5 Grade

Child #5 - Allergies or other needs

I understand a parent or guardian is required to stay on campus with children and assist as needed.

I understand

Name of parent who will be present:

I understand there is a required non-refundable monthly fee of $20 per child that is for supplies and staff costs.

I understand

I have read the Belief Statements of Indian Creek and...

Agree

Disagree

Have questions or concerns

Questions or concerns

Any other Children who will be on campus, not attending classes? (Parent or Guardian on campus is responsible for them)

Are there any other concerns we should be aware of?