Privacy Statement: This information will not be used for any purpose other than the Registration of your child. Child's Information Child's Full Name * Child's Gender * Male Female Child's Date of Birth * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20172018201920202021202220232024 Year Parent/Guardian Information Parent/Guardian Name * Street Address * City * State * Zipcode * Email Address This child is a resident of Bladen County * Yes No By typing my name below, I confirm that all information on this form is correct: Parent/Guardian Name * Submit
Privacy Statement: This information will not be used for any purpose other than the Registration of your child.