Contact Parent/Guardian *

First Name

Last Name

Student's Name *

First Name

Last Name

Phone *

(###)

###

####

Grade *

2nd

3rd

4th

5th

6th

7th

Do you have access to Parent Portal? *

Yes

No

What is Parent Portal?

Does the Little Disciples Enrichment Program have permission to use photos and videos of your child in educational or promotional media? *

Yes

No

Does your child qualify for free or reduced lunch?

Yes

No

Does your child have any learning disabilities?

Yes

No

If so, do they have an IEP?

Yes

No