Parent/Guardian Name 1(required)
Parent/Guardian Name 2
Emergency Contact (required)
Phone Number (required)
Home Address (required)
City(required)
Zip(required)
Your Email (required)
Authorized for Child Pickup (required)
Child Name 1 (required)
Birthday (required)
Age (required)
Gender (required) MaleFemale
Grade (required) —Please choose an option—PreschoolK123456
School (required)
Allergies/Special Needs (required)
Hobbies
Child Name 2
Birthday
Age
Gender —Please choose an option—MaleFemale
Grade —Please choose an option—PreschoolK123456
School
Allergies/Special Needs
Child Name 3
Image Permission
Yes, for Video, Print, & Web PresentationNo, I don't give permission
Mailing List
Yes, add me to Eastview's mailing listNo, do not add me to your mailing list
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