Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Ethnic Identity

(Check one)

Hispanic or Latino

Not Hispanic or Latino

Race

(Check one or more)

White

Black or African American

Asian

American Indian or Alaskan Native

Native Hawaiian or Other Pacific Islander

Name *

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Business Phone

(###)

###

####

Name

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Business Phone

(###)

###

####

What date would you like your child to join FPDS? *

MM

DD

YYYY

How will your child’s tuition be paid?

Private Pay

Subsidy Vouchers

Scholarships

Employer Paid