Child's Full Name *

Parent First Name *

Parent Last Name *

Phone *

Email *

Please list any allergy or medical information.

By checking this box, I consent to my child riding with an adult when the children do local deliveries and/or service projects. (If you do not give permission for your child to ride with an adult, we will let you know when we plan to be off campus.)

By checking this box, I do not consent to my child riding with an adult when the children do local deliveries and/or service projects.

Who will be picking up your child? *