Child Check Registration

Please view the instructional video about "Child Check" below.

Please complete the form below to submit your registration.

Father's Name*
First Last
Mother's Name*
First Last
Legal Guardian's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone Number*
Cell Phone Number*
May EBC text you at this number?*
Please list all individuals who have your permission to register OR release your child. NOTE: These individuals must be at least in the 6th grade, such as older siblings.*
Name of Child #1 being registered for "Child Check"*
First Last
Date of Birth of Child #1 being registered for "Child Check"*
Month
Day
Year
Grade of Child #1 being registered for "Child Check"*
Allergies of Child #1 being registered for "Child Check"*
Name of Child #2 being registered for "Child Check"
First Last
Date of Birth of Child #2 being registered for "Child Check"
Month
Day
Year
Grade of Child #2 being registered for "Child Check"
Allergies of Child #2 being registered for "Child Check"
Name of Child #3 being registered for "Child Check"
First Last
Date of Birth of Child #3 being registered for "Child Check"
Month
Day
Year
Grade of Child #3 being registered for "Child Check"
Allergies of Child #3 being registered for "Child Check"
If registering more than 3 children, list additional names, birthdays, and allergy information here
Comments
This field is for validation purposes and should be left unchanged.

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