New Child Enrollment Form

We are:

A new family at Triumph DC

Updating our information

Child's Name

Please complete a separate form for each child

First Name

Last Name

Child's Age

Child's Date of Birth

MM

DD

YYYY

Does your child have any allergies?

If YES, please list all allergies below.

YES

NO

List all allergies:

Anything else we should know about your child?

Parent / Guardian Information

Parent / Guardian Name

First Name

Last Name

Parent / Guardian Phone

(###)

###

####

Parent / Guardian Email

Additional Parent / Guardian Name

First Name

Last Name

Additional Parent / Guardian Phone

(###)

###

####

Additional Parent / Guardian Email

Emergency Contact Name

Please list an emergency contact that is different from parents/guardians listed above. In an emergency situation, we will contact the two individuals listed above before contacting this emergency contact.

First Name

Last Name

Emergency Contact Phone

(###)

###

####