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CRIS Health Card 2020-2021
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* Indicates required question
Email
*
Your email
STUDENT'S Last Name
*
Your answer
STUDENT'S First and Middle Name
*
Your answer
Gender
*
Female
Male
Other:
Address *
Your answer
City
*
Your answer
Zip Code
*
Your answer
County
*
Choose
Lexington
Richland
Other
Birthday
*
MM
/
DD
/
YYYY
Age
*
Your answer
End of day dismissal:
*
Check all that apply.
Bus
Car
Walk
Other:
Required
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