1.Parent/Guardian First and Last Name

First Name

Last Name

2.Parent/Guardian Email

3.Parent/Guardian Phone

4.Child 1 First and Last Name

Child 1 First Name

Child 1 Last Name

5.Child 1 Student Status

Penns Valley StudentPre-School Student or youngerOther (attends private, charter, or cyber charter, etc.)

6.Child 2 First and Last Name

Child 2 First Name

Child 2 Last Name

7.Child 2 Status

Penns Valley StudentPre-School Student or youngerOther (attends private, charter, or cyber charter, etc.)

8.Child 3 Name

Child 3 First Name

Child 3 Last Name

9.Child 3 Name

Child 3 First Name

Child 3 Last Name

10.Child 3 Status

Penns Valley StudentPre-school age or lowerOther (attends private, charter, or cyber charter, etc.)

11.Child 4 Name

Child 4 First Name

Child 4 Last Name

12.Child 4 Status

Penns Valley StudentPre-school age or lowerOther (attends private, charter, or cyber charter, etc.) 

13.Child 5 Name

Child 5 First Name

Child 5 Last Name

14.Child 5 Status

Penns Valley StudentPre-School age or lowerOther (attends private, charter, or cyber charter, etc.)

15.Child 6 Name

Child 6 First Name

Child 6 Last Name

16.Child 6 Status

Penns Valley StudentPre-School age or lowerOther (attends private, charter, or cyber charter, etc.)

17.Child 7 Name

Child 7 First Name

Child 7 Last Name

18.Child 7 Status

Penns Valley StudentPre-school age or lowerOther (attends private, charter, or cyber charter, etc.)

19.Child 8 Name

Child 8 First Name

Child 8 Last Name

20.Child 8 status

Penns Valley studentPre-school age or youngerOther (attends private, charter, or cyber charter, etc.)

21.Delivery Location

Name

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number at Delivery Location

*22.I understand that by Submitting this Registration, I am consenting to the release of contact information necessary to make deliveries to the specified location.(Required.)

Yes