Registration | Warm Hearts School For Creative Thinkers

PARENT/GUARDIAN INFORMATION

Parent's Name

Parent's/Guardian's Date of Birth

Email

Phone

Address

Emergency Contact Information (Name and Phone)

CHILD'S INFORMATION

Child's Name

Child's Date of Birth

List any allergies or medical concerns (Enter N/A if none):

Child's Gender

School Name and Address

Grade

Child's Teacher Name

UPLOADS & SERVICES

Does your child have an IEP/504 Plan? If so, upload below.

Yes

No

Parent/Guardian State Issued ID

Child's Birth Certificate

Picture of Child

IEP/504 Plan

I give Warm Hearts permission to photograph my child for program-related purposes, including social media, website, and promotional materials.

Signature: Acknowledgement of Warm Hearts Handbook & Transportation Form

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Registration Signature

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Registration Form