HGEC Spring 2021 Parent Intake Form

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HGEC Spring 2021 Parent Intake Form

Welcome to the Spring 2021 Semester! 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.***

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* Indicates required question

Email *

Your email

Parent Name(s) & Cell Numbers *

Your answer

Emergency Contact Information & Relationship *

Your answer

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. *

Your answer

Home Address

Your answer

Do you live in: *

Central Houston

Outside Beltway 8, it'll be a drive!

Other:

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