2024 HGEC Parents Intake Form

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Welcome to HGEC! Thank you for choosing to join us. Please provide some background information about yourself. ***We intend to keep your responses confidential between you and HGEC facilitators.***

Email *

Parent(s) Name(s) & Cell Numbers *

Name of Child(ren) enrolling. Please provide pronouns they are desirous of using at HGEC. *

Please provide Email addresses of Parents/ Legal Guardians that should be included in HGEC outgoing correspondence. *

Primary Contact: Of the parents/ legal guardians listed above living in the same household, please name the primary contact for communication with the Director and in-house facilitators. This would be for time sensitive needs, emergency or some other emerging onsite condition. A clear and positive line of communication will support HGEC’s efforts and enhance the energy we need to mindfully support our kids.

Emergency Contact Information & Relationship (in case parents cannot be reached via cell phone) *

Is there anyone other than the parents and emergency contact(s) listed above that are authorized to pick up your child(ren)? If so, please list their name below. *

Home(s) Address(es)

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