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Student's Name
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Student's Birthdate (MM/DD/YYYY)
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Student's Gender
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Male
Female
Allergies / Health Concerns
Legal / Custody Concerns
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Preschool Remote Learning ($115/month)
Pre-K Remote Learning ($160/month)
Parent 1 Name
Parent 1 Address
Parent 1 City
Parent 1 State
Parent 1 Zip
Parent 1 Phone
Parent 1 Email
Parent 2 Name
Parent 2 Address
Parent 2 City
Parent 2 State
Parent 2 Zip
Parent 2 Email
Parent 2 Phone
Photo Release
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I give consent to have my child photographed while at Learning Tree events and activities with the understanding that these photographs may be used in church and Learning Tree publications, websites, and social media. My child’s name will not be mentioned in connection with these photos.
I give consent to have my child photographed while at Learning Tree activities and activities with the understanding that these photographs will be for classroom and teacher use only. However, I do not wish for my child’s photograph to be used in church and Learning Tree publications, websites, and social media.
I do not wish for my child to be photographed while at Learning Tree event and activities.
Immunization Record
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I understand I must submit a copy of my child’s up-to-date immunization record in accordance to the State of Illinois, Department of Human Services for my child to be able to participate in Learning Tree sponsored activities or events. I understand that I have 30 days from the start of school to submit this form. If required paperwork is not submitted, my child will not be able to attend in-person activities.
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