Diplomat Chess

CHILD NAME

PARENT/GUARDIAN NAME 1

PARENT/GUARDIAN NAME 2

PHONE NUMBER 1

PHONE NUMBER 2

CHILD GRADE K 1 2 3 4 5 6 7 8

CHILD'S TEACHER IN SCHOOL

IS THERE ANYTHING ELSE WE SHOULD KNOW? ALLERGIES, SPECIALS NEEDS, ETC.

PICKUP Parent Pickup Aftercare

Kent Place School