EmailMe Form - 2025-2026 Back To School Registration

Parent/Guardian Name *

First Last

Phone *

### - ### - ####

Email *

How do you prefer us to contact you? *

Text Message on our cell phone

Email

**We will only communicate through email or text message in the interest of time and efficiency. PLEASE NO PHONE CALLS! Thank you :)

Will your children be: *

Going to School

Home Schooled

Distance Learning

What City do you live in? *

Bismarck

Mandan

Other

Living Arrangements *

APPOINTMENTS ARE ONLY FOR STUDENTS KINDERGARTEN THROUGH HIGH SCHOOL

Please provide the following information for children who will be attending the event.

CHILDREN MUST BE PRESENT AT THE APPOINTMENT TO BE SERVED!

ALL INFORMATION IS REQUIRED FOR EACH CHILD

Child 1

Child's Name (Kindergarten - Highschool ONLY) *

Child's Birthdate *

MM / DD / YYYY

Please select your child's grade. *

Please select your child's school *

Child 2

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 3

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 4

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's school

Please select your child's grade.

Child 5

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 6

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 7

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 8

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 9

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

Child 10

Child's Name (Kindergarten - Highschool ONLY)

Child's Birthdate

MM / DD / YYYY

Please select your child's grade.

Please select your child's school

APPOINTMENTS ARE ONLY FOR STUDENTS KINDERGARTEN THROUGH HIGH SCHOOL

ALL INFORMATION IS REQUIRED FOR EACH CHILD

- - - - - - - - - - - - - - - - - - - - - - THANK YOU!!! - - - - - - - - - - - - - - - - - - - - - - -