Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Child's Name (Student #2)

First Name

Last Name

Date of Birth (Student #2)

MM/DD/YYYY

MM

DD

YYYY

Child's Name (Student #3)

First Name

Last Name

Date of Birth (Student #3)

MM/DD/YYYY

MM

DD

YYYY

Physician Name *

First Name

Last Name

Physician Phone Number *

(###)

###

####

Parent/Guardian #1 *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Parent/Guardian #2

First Name

Last Name

Address same as Parent/Guardian #1

Yes

Mailing Address Parent/Guardian #2

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Parent/Guardian #2

Country

(###)

###

####

We ask that you choose at least one way to support and interact with the Dharma School community each year. Please check as many options that you would consider. Thank you very much!

Assisting in a classroom

Leading a relevant activity (such as a yoga lesson, martial arts lesson, calligraphy lesson, Ikebana lesson, dancing/movement exercise, craft project, etc.)

Leading a Dharma lesson (such as reading a storybook, sharing a personal story, etc.)

Co-chairing the annual Halloween Party

Coordinating a fundraiser

Organizing a field trip

Would you be interested in Temple Membership information?

Yes, please!

No, thank you.