Thank you! Thank you for registering. To complete the process, please fill out the medical form below Child's InformationHow many children does this form cover?* 1 2 3 4 or more Child's Name* First Last Gender:* Male Female Age*Please enter a number from 0 to 18.Grade*Any serious illnesses or hospitalizations?*Any allergies? (please list)* Not Applicable Any medications given regularly? (please list)* Not Applicable Any physical disabilities?* Not Applicable Use of any aides? (glasses, hearing aids, etc.)* Not Applicable Is your child receiving any special services in school?* Not Applicable Name of 2nd Child* First Last Gender:* Male Female Age*Please enter a number from 0 to 18.Grade*Any serious illnesses or hospitalizations?*Any allergies? (please list)* Not Applicable Any medications given regularly? (please list)* Not Applicable Any physical disabilities?* Not Applicable Use of any aides? (glasses, hearing aids, etc.)* Not Applicable Is your child receiving any special services in school?* Not Applicable Name of 3rd Child* First Last Gender:* Male Female Age*Please enter a number from 0 to 18.Grade*Any serious illnesses or hospitalizations?*Any allergies? (please list)* Not Applicable Any medications given regularly? (please list)* Not Applicable Any physical disabilities?* Not Applicable Use of any aides? (glasses, hearing aids, etc.)* Not Applicable Is your child receiving any special services in school?* Not Applicable Name of 4th Child* First Last Gender:* Male Female Age*Please enter a number from 0 to 18.Grade*Any serious illnesses or hospitalizations?*Any allergies? (please list)* Not Applicable Any medications given regularly? (please list)* Not Applicable Any physical disabilities?* Not Applicable Use of any aides? (glasses, hearing aids, etc.)* Not Applicable Is your child receiving any special services in school?* Not Applicable Mother/Father or Guardian Name* First Last Mother/Father or Guardian Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Contact Phone*Mother/Father or additional Guardian First Last Mother/Father or additional Guardian Address (if different from above) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother/Father or additional Guardian Preferred PhoneEmergency Contact (other than Mother\Father\guardian)* First Last Emergency Contact Phone*Emergency Contact Relationship* Δ
