Emergency Information Card
Child's Full Name
Date Of Birth
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Allergies to Medicine(s)
*
N/A not applicable
Allergies to Food(s)
*
N/A not applicable
Special Procedures required in caring for your child:
*
Parent / Guardian Information
*
Parent / Guardian Information
Emergency Contact other than parent (1)
*
Emergency Contact other than parent (2)
Emergency Contact other than parent (3)
Which School Are You Interested In?
*
Kids R Kids Of Legends Ranch
Kids R Kids of Woodson's Reserve
Parent / Guardian Signature
*
Date
Submit
Should be Empty: