Change Information Form

• Child's Name*
  First Last
• Parent/Guardian Name*
  First Last
• Address*
  Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• School*
• Home Phone
• Cell Phone
• Work Phone
• Add/Delete Person(s) who are able to pick-up your child: *Only the parent/guardian who signed the registration form can add/delete the pick-up information.
• Name
• Phone
• Action
  • Add
  • Delete
• Name
• Phone
• Action
  • Add
  • Delete
• Name
• Phone
• Action
  • Add
  • Delete
• Signature*

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• Change Information Form
• Forms / Information
• Program Components
• Photos / Video

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