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Little Cane’s Academy
Application
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Email
*
Your email
Name of Child (please include nickname)
Your answer
Date of Application
*
Your answer
Date of Birth (01/01/2000)
MM
/
DD
/
YYYY
Name of parent/s or guardian
Your answer
Cell phone #
Your answer
Address
Your answer
Other children in the family along with their ages:
Your answer
Please submit a brief statement as to why you would like your child to attend Little Cane's Academy.
Your answer
Person to contact and emergency telephone number (other than your own)
Your answer
I give permission for my child to be photographed/videotaped.
Yes
No
Any allergies or pertinent information we should have about your child.
Your answer
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