2019-2020 EAH Registration
K-12 Registration
Email address *
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address
Your answer
School Attending
Your answer
Grade *
Ethnicity
Shirt Size *
Teacher's Name
Your answer
Parent's Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Facebook Account Name (we have a parent group)
Your answer
Primary Care Physician *
Your answer
Allergies *
Your answer
Medication
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number
Your answer
Areas of Concern *
Family Members *
Your answer
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?
Do you give your child permission to participate in field trips? *
Do you give your child permission to watch movies and age appropriate documentaries? *
Venture Outdoors Waiver for 3rd - 12th Grade (please copy and paste in your web browser. You can fill one out for all children you enroll in our program.)
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