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2019-2020 EAH Registration
K-12 Registration
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Choose
Male
Female
Address
Your answer
School Attending
Your answer
Grade
*
Choose
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Ethnicity
Choose
African American
Caucasian
Native American
Latino
Asian American
Native Hawaiin/Pacific Islander
Other
Shirt Size
*
XS
S
M
L
XL
YS
YM
YL
YXL
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
*
Math
Reading
Other:
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?
*
Option 1
Yes
No
Do you give permission for photos to be taken of your child?
Yes
No
Clear selection
Do you give your child permission to participate in field trips?
*
Yes
No
Do you give your child permission to watch movies and age appropriate documentaries?
*
Yes
No
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.)
https://waiver.smartwaiver.com/w/5c48c8296ee0b/web/?wautofill_tag=0064600000RqWi2
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