Child’s Name ___________________________________Age ____

Current Grade ____ Date of Birth ___________  School ________________________

Parent’s Name _________________________ Daytime Phone (      ) ______________

Home Address__________________________  Evening Phone (      )_______________

City __________________ State ___ Zip code ___________ Email________________

Please fill out and drop in the Building Blocks for Learning Envelope in your school office.

For more information contact Terri Maguire (972)412-0970 or buildingblocksforlearning@verizon.net.