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REGISTRATION FORM

Name *
Name
Cell Phone # *
Cell Phone #
Spouse's Name
Spouse's Name
Spouse's Cell Phone #
Spouse's Cell Phone #
You may be asked to come to the EK room during service for a variety of reasons: - if we sense your child is in some form of distress and have tried to comfort your child with no success - if your child is not responding to the volunteers in such a way as to be a continuous disruption to the EK environment - if we do not have the necessary items to care for your child - if there is any type of emergency
Child 1's Name *
Child 1's Name
(Please list any health issues, allergies, or emotional/learning/developmental concerns)
Child 2's Name
Child 2's Name
(Please list any health issues, allergies, or emotional/learning/developmental concerns)
Child 3's Name
Child 3's Name
(Please list any health issues, allergies, or emotional/learning/developmental concerns)
EK POLICIES
Please check the box if you agree with the following statements: *