Portage, MI Multiple Child Enrollment Form

Parent Name *

First Name

Last Name

Additional Parent Name

First Name

Last Name

Child #1 Name *

First Name

Last Name

Child #1 Birthdate *

MM

DD

YYYY

Child #2 Name

First Name

Last Name

Child #2 Birthdate

MM

DD

YYYY

Child #3 Name

First Name

Last Name

Child #3 Birthdate

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone *

(###)

###

####

Work Phone

(###)

###

####

Home Phone

(###)

###

####

Desired Start Date

MM

DD

YYYY