|
What is your child's/children's last name?
|
|
|
Primary home address, city and ZIP
|
|
|
Home telephone
|
|
|
Second phone (cell or work)
|
|
|
Mother's name
|
|
|
Mother's religious roots
|
|
|
GPUC member?
|
Yes
No
|
|
Mother's occupation
|
|
|
Mother's email address
|
|
|
Father's name
|
|
|
Father's religious roots
|
|
|
GPUC member?
|
Yes
No
|
|
Father's occupation
|
|
|
Father's email address
|
|
|
Please list each child's first name, age & sex, birth date, grade they are attending, and at which school
|
|
|
Are there any allergies, medicines, special family situations or other concerns that we should be aware of?
|
|
|
This child resides with:
|
|
|
Name of parent filling this form
|
|
|
Email Address:
|
|
|
|
