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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone Number*Cell Phone Number*May EBC text you at this number?*Please SelectYesNoPlease 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 hereCommentsThis field is for validation purposes and should be left unchanged.