Born Learning Registration Form

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Born Learning Academy @ Northside School 520 N Genesee St., Morrison
Monday and Thursday • 5pm • April 1, 4, 8, 15, 22 and 25, 2019

Register by March 15, 2019 by returning this form to United Way of Whiteside County by U.S. mail, fax, on our website or call us.

We are United Way of Whiteside County ● 502 1st Ave., Sterling, Ill. 61081 Phone: 815-625-7973 ● Fax: 815-625-0447 ● website: www.uwwhiteside.org

Born Learning Registration Form

Parent Name(s)

Street Address

City

State

Zip

Cell Phone

Email Address

List all children including their names and ages:

Child 1 Name

Birthdate (month/day/year)

Child 2 Name

Birthdate (month/day/year)

Child 3 Name

Birthdate (month/day/year)

Child 4 Name

Birthdate (month/day/year)

Diaper sizes/pull-ups sizes your children wear (to be used for incentive purposes)

Attending supper at the academy workshops? (offered each night at 5pm)

Yes Number No

Do you need child care for your children?

Yes Number of School Age Children Ages Number of Infants & Toddlers Ages No

L.I.F.E. is our version of the Dolly Parton Imagination Library. Children ages 0-5 who reside in Whiteside County registered for this program receive a free book in the mail each month up until their 5th birthday.

Please Register My Child for L.l.F.E.

United Way of Whiteside County ● 502 1st Ave., Sterling, Ill. 61081 P: 815-625-7973 ● F: 815-625-0447 ● uwwhiteside.org ● Like us on Facebook ● Find us on Twitter

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