Peoria Friendship House Online Registration

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student's School*

Grade Level*

Are you able to provide transportation for your child to our building if our transportation is full?*

Disabilities or Activity Restrictions? (i.e Asthma, Epilepsy, etc) (Type N/A if NONE)*

Is there any info that you can provide to assist when working w/your child? (Type N/A if NONE)*

Does you child have any allergies? If so, please list. (Type N/A if NONE)*

Is your child on any medications? If so please list. (Type N/A if NONE)*

Ethnicity?*

Hispanic/Latino? (Y/N)*

Please click on the Search button below, then choose the class according to your student(s) grade level. If you are registering for Summer Break Camp, you will need to enroll your child into each week that you would like them to attend.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student's School*

Grade Level*

Are you able to provide transportation for your child to our building if our transportation is full?*

Disabilities or Activity Restrictions? (i.e Asthma, Epilepsy, etc) (Type N/A if NONE)*

Is there any info that you can provide to assist when working w/your child? (Type N/A if NONE)*

Does you child have any allergies? If so, please list. (Type N/A if NONE)*

Is your child on any medications? If so please list. (Type N/A if NONE)*

Ethnicity?*

Hispanic/Latino? (Y/N)*

Please click on the Search button below, then choose the class according to your student(s) grade level. If you are registering for Summer Break Camp, you will need to enroll your child into each week that you would like them to attend.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student's School*

Grade Level*

Are you able to provide transportation for your child to our building if our transportation is full?*

Disabilities or Activity Restrictions? (i.e Asthma, Epilepsy, etc) (Type N/A if NONE)*

Is there any info that you can provide to assist when working w/your child? (Type N/A if NONE)*

Does you child have any allergies? If so, please list. (Type N/A if NONE)*

Is your child on any medications? If so please list. (Type N/A if NONE)*

Ethnicity?*

Hispanic/Latino? (Y/N)*

Please click on the Search button below, then choose the class according to your student(s) grade level. If you are registering for Summer Break Camp, you will need to enroll your child into each week that you would like them to attend.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student's School*

Grade Level*

Are you able to provide transportation for your child to our building if our transportation is full?*

Disabilities or Activity Restrictions? (i.e Asthma, Epilepsy, etc) (Type N/A if NONE)*

Is there any info that you can provide to assist when working w/your child? (Type N/A if NONE)*

Does you child have any allergies? If so, please list. (Type N/A if NONE)*

Is your child on any medications? If so please list. (Type N/A if NONE)*

Ethnicity?*

Hispanic/Latino? (Y/N)*

Please click on the Search button below, then choose the class according to your student(s) grade level. If you are registering for Summer Break Camp, you will need to enroll your child into each week that you would like them to attend.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Student's School*

Grade Level*

Are you able to provide transportation for your child to our building if our transportation is full?*

Disabilities or Activity Restrictions? (i.e Asthma, Epilepsy, etc) (Type N/A if NONE)*

Is there any info that you can provide to assist when working w/your child? (Type N/A if NONE)*

Does you child have any allergies? If so, please list. (Type N/A if NONE)*

Is your child on any medications? If so please list. (Type N/A if NONE)*

Ethnicity?*

Hispanic/Latino? (Y/N)*

Please click on the Search button below, then choose the class according to your student(s) grade level. If you are registering for Summer Break Camp, you will need to enroll your child into each week that you would like them to attend.

Enroll in Classes

Select Class

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Required Policies

(Show-Hide Details)