Children's Center Enrollment Form Child's Name * Birth Date * Year Year2004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Child's preferred pronouns Second Child's Name Second Child's Birth Date Year Year2004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Second Child's preferred pronouns Parent/GuardianPlease list parent/guardian affiliated with Evergreen first. Parent/Guardian Name * Parent/Guardian's preferred pronouns Evergreen ID# Email Address * Cell Phone Number Relationship to Evergreen (check all that apply) * Enrolled Student Student Planning to Enroll Evergreen Staff or Faculty Community Member Desired Date of Enrollment Year Year20182019202020212022 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 How did you hear about the Children's Center? Additional information about your child or plans which may affect your child's registration: