Child's Code
Date of Birth
Mother's Name
Father's Name
Home Address (include city, state, zip)
Phone Number
Your Email
Registering for:
—Please choose an option—Winter (Jan- May)Summer (June- Aug)Fall (Sept- Dec)
What programs is your child involved with?
IIPPALSTIESCALSGroups onlyBLIPBLIP onlyConsultationPREPAcademy
Is this a change to your original schedule for the current cycle?
*Note: All schedule changes made after each cycle deadline or without 30 days notice will be subject to a $50 registration fee.
YesNo
Your Preferred Schedule Options:
*Please note that PALS and TIES students may only come from 2:00 to 6:00 PM on week days. There is limited availability on Saturdays. If the BWF cannot schedule your child on a Saturday, the BWF will use your alternate schedule option or contact you. If your child is only attending for group sessions, please choose Not Applicable below and the BWF will contact you regarding the appropriate group and schedule.
Monday
8 - 108 - 118 - 129 - 119 - 121 - 31 - 41 - 62 - 42 - 63 - 64 - 6Not applicable
Tuesday
Wednesday
8 - 108 - 118 - 129 - 119 - 121- 31- 41 - 62 - 42 - 63 - 64 - 6Not applicable
Thursday
8- 108- 118- 129- 119- 121- 31- 41- 62- 42- 63- 64- 6Not applicable
Friday
Saturday
9- 121- 31- 53- 5Not applicable
Preferred Schedule to Start:
Your Alternate Schedule Options:
8- 108- 118- 129- 119- 121- 31- 41- 51- 62- 42- 52- 63- 53- 64- 6Not applicable
9- 119- 1210- 121- 31- 53- 5Not applicable
Alternate Schedule to Start:
Please include any additional information or conflicts such as vacation time or doctor appointments you would like the BWF to know regarding your child's schedule.
I understand that the Brent Woodall Foundation (BWF) may not be able to accommodate all preferred schedules, but will do everything it can to use my preferred schedule. I understand that if my preferred schedule does not work, the BWF will use a combination of my preferred and alternate schedule. I understand that I will be charged a $50 registration fee if my schedule is turned in after the cycle registration deadline and without 30 days notice. I understand that the BWF will contact me with my child's cycle schedule approximately two weeks prior to start of the new cycle.
Type Electronic Signature:
Today's Date:
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