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Work Entry
Added: 9/7/2024
CHILD
Information
First Name
First Name is required.
Last Name
Last Name is required.
DOB
Jan
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1918
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1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
DOB cannot be a future date.
Gender
Male
Female
Gender is required.
Allergies
Grade
None
PreK (Age 4 before 9/1)
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Grade is required.
Parent/Guardian
Information
NOTE: This information will be used for verification if you ever misplace your child’s pick up tag, or if we need to reach you during programming.
First Name
First Name is required.
Last Name
Last Name is required.
Email
Email address is not valid
Email is required.
Phone Number
Phone Number is required.
DOB
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
DOB cannot be a future date.
Gender
Male
Female
Gender is required.
Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
What brought you to Cornerstone?
Christmas
Easter
Friend/Family
Harvest Festival
Online
Other
What brought you to Cornerstone? is required.
Do you have additional children to add?
Yes
No
Do you have additional children to add? is required.
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