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Child Information Year applying for: 2011 Grade Level: -Select one- 1st 2nd 3rd 4th 5th 6th First Name: Last Name: Date of Birth: Gender: Male Female Sibling(s) currently attending our school: Previous School: School in Pasco: Does child have IEP plan?: (Individual Education Plan)  YES NO Please specify: Other

Parent/Address Information Street Address: City: Zip: 1st Parent's Name: Home Phone: Email: Cell Phone: 2nd Parent's Name: Home Phone: Email: Cell Phone: Addl. Comments:

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