EKids Pre-Registration Form
Parents/Guardian Full Name *
Your answer
Child's Name *
Your answer
School
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Grade *
Your answer
Siblings
Please include DOB for each sibling
Your answer
Allergies
Your answer
Medical info we should know
Your answer
Contact Info
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
*
Phone
Your answer
*
Email
Your answer
Emergency Contact
Your answer
Trusted People (Individuals who can check out your child)
Your answer
Not Authorized for Pickup (Individuals who cannot check out your child)
Your answer
Submit
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