Registration Form & EEC Face Sheet

Registration Form & EEC Face Sheet
Child Name

First NameLast Name
Child Date of Birth

MonthDayYear
Date
Gender
Height
Weight
Eye Color
Hair Color
Primary Language
Parent/Guardian Information - If you are registering a child and are a legal guardian, you may be required to show proof of legal guardian status.
Parent Name (First, Last)
Home Address
City,State
Zip Code
Parent E-Mail
Relationship to Child (Mother, Father, Guardian, Etc.)
Cell Number
Secondary Number
Employer Information - Employer Name
Employer Address include City and State
Parent Name #2 (First, Last)
Home Address
City, State
Zip Code
Parent E-Mail
Relationship to Child (Mother,Father,Guardian,Etc.)
Cell Number
Secondary Number
Employment Information - Employer Name
Employer Address include City and State
Monday-FridayMonday, WednesdayMonday, Wednesday, FridayTuesday, ThursdayTuesday, Thursday, FridayOther
8:30-1:007:30-1:008:30-3:307:30-3:30Other
Signature
Date

MonthDayYear
Date
Should be Empty: