• • Child's First Name *
    
    
• • Age: *
    
    
• • Gender *
    ...FemaleMale
    
• • Attending which School? *
    ...Surline ElementarySurline Middle SchoolRose City ElementaryRose City Middle SchoolWhittemore Prescott School
    
• • Child's Teacher: *
    
    
• • Grade: *
    
    
• • Name of Person Entering Form Information *
    
    
• • Relationship to Child *
    ...TeacherCounselorAdministrator (School)
    
• • Parent Name
    
    First
    
    Last
• • Parent Phone Number
    
    
    
    
    
    

• • ---

• • Back Pack - Enter size
    ...SmallMediumLarge
    
• • Socks - Enter shoe size:
    
    
• • Underwear - Enter size:
    
    
• • Tennis Shoes - Enter size
    
    
• • Winter Coat - Enter size:
    
    
• • Gloves - Enter size
    ...SmallMediumLarge
    
• • Winter Scarf
    No
    Yes
    
• • Winter Hat
    No
    Yes
    
• • Boots - Enter Size:
    
    
• • Snowpants - Enter size:
    
    
• • Notes/Comments
    
    

Authentication Text*
(Enter the text in the image above into this field.)

NOTE: Do Not Alter These Fields: