LRSD Parents Make a Difference Registration

Name:
Daytime or Home Phone:
Email address:
Address:
City:
Zip:

I am a:

Number of your children attending:
Elementary Middle High

Please tell us how many children attend each school.

I have student(s) attending

I have student(s) attending

I have student(s) attending

I have student(s) attending

I have student(s) attending

Please list the number of children, and their ages, who will need child care. Childcare is available for children ages 3-11.

Would you like to tell us anything else?