Little Learners Academy Registration - Keene ISD Little Leaders Academy

Before completing this registration form, you understand that the registration fee is non refundable. Please initial that you understand and agree.

Today's Date

Must contain a date in MM/DD/YYYY format.

Requested First Day of Attendance

Must contain a date in MM/DD/YYYY format.

Child's Name

First

Last

Child's Date of Birth

Must contain a date in MM/DD/YYYY format.

Child's Address

Address Line 1

Address Line 2

City

State

Zip Code

Gender

Male
Female

Do You Have Another Child to Register

Yes
No

2nd Child's Name

First

Last

2nd Child's Date of Birth

Must contain a date in MM/DD/YYYY format.

2nd Child's Gender

Male
Female

Parent Guardian #1

First

Last

Parent Guardian #1 Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent Guardian #1 Email

Parent Guardian #1 Cellphone

Parent Guardian #1 Workphone

Parent Guardian #1 Work Address

Address Line 1

Address Line 2

City

State

Zip Code

Signature

By entering your name in the space above, you are effectively providing your signature.

Do You Want Us to Have a 2nd Parent Guardian Approved for Your Child?

Yes
No

Parent Guardian #2 Name

First

Last

Parent Guardian #2 Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent Guardian #2 Email

Parent Guardian #2 Cellphone

Parent Guardian #2 Workphone

Parent Guardian #2 Work Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent Guardian #2 Signature

By entering your name in the space above, you are effectively providing your signature.

ENROLLMENT: Prior to your child's attendance at Keene Little Leaders Academy, all enrollment information must be completed, signed and returned to the school office at 3625 US 67, Keene, Texas 76059 along with your child's non refundable registration fee.

Little Leaders Academy Registration