JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Registration Form for ECC
Thank you for your interest in Risen Savior's Early Childhood Center. If you have any questions while completing the enrollment forms, please contact the school office at 480.802.1505.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student Information
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Child's Birthday
*
(xx/xx/xxxx)
Your answer
Gender
*
Male
Female
Special Needs
List any special needs, allergies, or medical conditions
Your answer
Phone Number
*
Enter the preferred number to contact you. (xxx-xxx-xxxx)
Your answer
Child lives with:
*
Mother
Father
Both
Other:
Church
Name of church currently attending.
Your answer
Baptized
Has your child been baptized?
Yes
No
Clear selection
Family Information
Primary Caregiver/Payer
This section relates to the child's primary caregiver. Payers have access to the Procare Parent Engagement app.
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Enter the preferred email address to contact you.
Your answer
Primary Mobile Phone
*
(xxx-xxx-xxxx)
Your answer
Address
Enter if different from student.
Your answer
Employer Name
Your answer
Occupation
Your answer
Work Phone
Your answer
Secondary Caregiver/Payer (optional)
This section relates to the child's secondary caregiver and also has access to Procare Parent Engagement app.
First Name
Your answer
Last Name
Your answer
Secondary Payer Email Address
Your answer
Secondary Mobile Phone
(xxx-xxx-xxxx)
Your answer
Address
Enter if different from student.
Your answer
Employer Name
Your answer
Occupation
Your answer
Work Phone
Your answer
Child's Race
This item is optional and is only used for reporting purposes to accreditation, state, and other agencies as requested. Names are never associated with demographic information.
American Indian
Asian
African American
Native Hawaiian or Other Pacific Islander
White
Multi-Cultural
Other:
Child's Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Clear selection
Next
Page 1 of 4
Clear form
Never submit passwords through Google Forms.
This form was created inside of Risen Savior Lutheran Church and School.
Report Abuse
Forms
