KIDS - Registration Form

Please Note: The information you provide on this form will be used to generate name tags and mailing labels. Please be accurate, and use appropriate formats.

	Name:
	(Leave blank - office use only):
	Home Address:

	Home City:	State: ZIP:
	County:
	Home Phone:
	E-mail:

	Username:	(part of e-mail address before the "@")
	Teacher:	Yes No
	Administrator:	Yes No
	Other:
	Evaluate Staff:	Yes No
	Position:
	District Number:
	District Name:
	County:
	School Building:
	School Address:

	School City:	State: ZIP:
	School Phone: