2020-2021 Learning Hub & EAH Registration
K-12 Registration
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Email *
Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address
School Attending
Grade *
Ethnicity
Teacher's Name
Parent's Name *
Phone Number *
Email Address *
Facebook Account Name (we have a parent group)
Primary Care Physician *
Allergies *
Medication
Emergency Contact Name *
Emergency Contact Phone Number
Areas of Concern *
Family Members *
Do you give A Giving Heart permission to use the child's name and/or voice, for all audio and or video in A Giving Heart's activities? *
Do you give permission for photos to be taken of your child?
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Do you give your child permission to receive educational assistance virtually? *
Do you give your child permission to participate in field trips? *
Do you give your child permission to watch movies and age appropriate documentaries? *
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