Enrollment Form - Lovin' The Skin I'm In

Enroll your child today using the form below.

"*" indicates required fields

Parent/Guardian First and Last Name*

Parent/Guardian Phone*

Parent/Guardian Email Address*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's Name*

School Child Attends*

Grade in School*

Extra Curricular Activities*

Services Child Receives

(i.e. Counseling, Big Brothers/Big Sisters, etc.)

Allergies (if applicable)

Programs*

Please list which programs you participate in out of the following list: FoodShare, Free or Reduced Price Lunch, School Breakfast Program, WIC, Healthy Start, Head Start, The Home Energy Assistance Program, TEFAP, Medical Assistance, Badger Care, Wisconsin Shares Child Care.

Media Release*

Do you grant Lovin' the Skin I'm in permission release photos/media of your child? Check one.

Yes I do.

No I don't.

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