Wonder Junction at Highland Heights Christian Church

Street

Street 2

City

State/Province

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

First Name

Last Name

Gender

Male

Female

Birth Date

Age Group

Ages 3(potty trained) - 5(haven't been to K)

Completed K - Completed 3rd grade

JUNIORS Completed 4th grade - Completed 6th grade

MS/HS(completed 7th grade - 12th grade)

Food Allergies

Details

Medical Concerns

Details

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