Wellspring Kids Registration

If your child has any special needs that we should know about, such as allergies, physical/learning disabilities, family stress (separation, divorce, death, recent move, etc.), or any other needs you feel are significant, please let us know.

If you have more than 3 children, please fill out an additional form.
Step 1: Kid's Information

If your child has any special needs that we should know about, such as allergies, physical/learning disabilities, family stress (separation, divorce, death, recent move, etc.), or any other needs you feel are significant, please let us know.
 
Please select all that apply.
 
 
 
 
 
 
 
 
Please select all that apply.
 
 
 
 
 
 
 
 
Please select one option.
 
 
 
 
 
 
 
Step 2: Address Information

Please fill out the information for the primary residence of the child.
 
 
Step 3: Parent/Guardian Information

Please fill out the information for the parent/guardian responsible for the child being registered.
 
 
 
 
 
Step 4: Parent/Guardian Release

Please select all that apply.
Please select all that apply.

Description

If your child has any special needs that we should know about, such as allergies, physical/learning disabilities, family stress (separation, divorce, death, recent move, etc.), or any other needs you feel are significant, please let us know.

If you have more than 3 children, please fill out an additional form.