School Information Inquiries Please Fill out the form below Date MM DD YYYY How Did You Hear About Us? Parent Name * First Name Last Name Parent Email Address * May We Email You? Yes No Parent Mailing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Relationship to Child Child's Name First Name Last Name Child's Birth Date MM DD YYYY Child's Gender Home Phone (###) ### #### Work Phone (###) ### #### Cell Phone (###) ### #### Hours of Care Needed Currently Attends School At Does your child receive speech therapy? Yes No If yes, please provide the location they receive speech therapy? Are you a public service employee (i.e. Fire Department, U of A Student, Police Department)? Yes No Are you DES Eligible? Yes No Is there anything else we should know about your child? Thank you!
