FUMP 2023-2024
Registration

Please fill out this form and drop off a registration fee of $125 for one child or $175 per family registration fee to our office to reserve a place for your child(ren). This fee is non-refundable.

Child's Name

First Name

Last Name

Sex

Birthdate

YYYY

Potty Trained?

Yes

To better meet the needs of your child, please share if there are any concerns we should be aware of:

(e.g., allergies, restrictions, conditions)

Physician Name

First Name

Last Name

Physician Phone Number

(###)

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Parent 1 Name

First Name

Last Name

Parent 1 Email

Parent 1 Home Phone

(###)

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Parent 1 Mobile Phone

(###)

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Parent 1 Work Phone

(###)

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Parent 1 Occupation

Parent 2 Name

First Name

Last Name

Parent 2 Email

Parent 2 Home Phone

(###)

###

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Parent 2 Mobile Phone

(###)

###

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Parent 2 Work Phone

(###)

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Parent 2 Occupation

In case of emergency, what is the best way to reach you?

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What days/times will your child(ren) attend?

Day Options: Monday-Friday, M/W/F, T/Th Time Options: Half Day (9-12), Morning w/ Lunch (9-12:30), Full Day (7-5)

FUMP 2023-2024Registration

FUMP 2023-2024
Registration