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Prime Time Family Reading Time

Registration is now open for Prime Time Family Reading Time! Click on the link & send back to LaFamilia Resource Center, 114 W. Clarence St. Lake Charles, La 70601

Uploaded by

Erica Brown
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
50 views

Prime Time Family Reading Time

Registration is now open for Prime Time Family Reading Time! Click on the link & send back to LaFamilia Resource Center, 114 W. Clarence St. Lake Charles, La 70601

Uploaded by

Erica Brown
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

pt_registration_eng 9/10/10 1:19 PM Page 1

Name of parent: _________________________________


Address: ______________________________________
____________________________________________
Telephone: _____________________________________

Yes! I plan to attend PRIME TIME


with
my child (children).

Email: ________________________________________
Do you need transportation?

Yes No

Names of child (children):


Child: ____________________ Child: ____________________ Child: ____________________

Child: ____________________

Date of Birth: _______________

Date of Birth: _______________

Date of Birth: _______________

Date of Birth: _______________

Race: ____________________

Race: ____________________

Race: ____________________

Race: ____________________

Male Female

Male Female

Male Female

Male Female

Name of parent: _________________________________


Address: ______________________________________
____________________________________________
Telephone: _____________________________________

Yes! I plan to attend PRIME TIME


with
my child (children).

Email: ________________________________________
Do you need transportation?

Yes No

Names of child (children):


Child: ____________________ Child: ____________________ Child: ____________________

Child: ____________________

Date of Birth: _______________

Date of Birth: _______________

Date of Birth: _______________

Date of Birth: _______________

Race: ____________________

Race: ____________________

Race: ____________________

Race: ____________________

Male Female

Male Female

Male Female

Male Female

Name of parent: _________________________________


Address: ______________________________________
____________________________________________
Telephone: _____________________________________

Yes! I plan to attend PRIME TIME


with
my child (children).

Email: ________________________________________
Do you need transportation?

Yes No

Names of child (children):


Child: ____________________ Child: ____________________ Child: ____________________

Child: ____________________

Date of Birth: _______________

Date of Birth: _______________

Date of Birth: _______________

Date of Birth: _______________

Race: ____________________

Race: ____________________

Race: ____________________

Race: ____________________

Male Female

Male Female

Male Female

Male Female

pt_registration_bil 9/10/10 1:20 PM Page 1

Nombre de Padre y/o de Madre: ________________________


Direccin: _____________________________________
____________________________________________
Telfono: ______________________________________

S, pienso ir a PRIME TIME


con
mi(s) hijo(s).

Correo electrnico: ________________________________


Necesitar usted transportacin?

S No

Nombres de los nios:


Nombre: __________________

Nombre: __________________

Nombre: __________________

Nombre: __________________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Nacionalidad: _______________

Nacionalidad: _______________

Nacionalidad: _______________

Nacionalidad: _______________

Masculino Femenino

Masculino Femenino

Masculino Femenino

Masculino Femenino

Nombre de Padre y/o de Madre: ________________________


Direccin: _____________________________________
____________________________________________
Telfono: ______________________________________

S, pienso ir a PRIME TIME


con
mi(s) hijo(s).

Correo electrnico: ________________________________


Necesitar usted transportacin?

S No

Nombres de los nios:


Nombre: __________________

Nombre: __________________

Nombre: __________________

Nombre: __________________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Nacionalidad: _______________

Nacionalidad: _______________

Nacionalidad: _______________

Nacionalidad: _______________

Masculino Femenino

Masculino Femenino

Masculino Femenino

Masculino Femenino

Nombre de Padre y/o de Madre: ________________________


Direccin: _____________________________________
____________________________________________
Telfono: ______________________________________

S, pienso ir a PRIME TIME


con
mi(s) hijo(s).

Correo electrnico: ________________________________


Necesitar usted transportacin?

S No

Nombres de los nios:


Nombre: __________________

Nombre: __________________

Nombre: __________________

Nombre: __________________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Fecha de Nacimiento: ___________

Nacionalidad: _______________

Nacionalidad: _______________

Nacionalidad: _______________

Nacionalidad: _______________

Masculino Femenino

Masculino Femenino

Masculino Femenino

Masculino Femenino

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