EWECC Parent Group Sign-upWe ask all parents or guardians to please fill out the following form. It is important that we have current contact information about you and your child. When you complete this form, you can expect to periodically receive information about:Administrative Directives from the CenterNews about the CenterCenter-wide EventsClassroom updates from teachersWe promise to respect your privacy and not to use your personal information for any purpose other than informing you about the child or school activities.Your Child's Name* First Last Child's Date of Birth* MM DD YYYYProgram*Select the program that your child is enrolled inToddlerJunior Pre-KPre-KClassroomSelect which class your child is inRoom 1Room 2Room 3Room 4Room 5Room 6Room 7Room 8Add 2nd child who is enrolledyesno2nd Child InfoYour 2nd Child's Name* First Last Date of Birth - child 2* MM DD YYYYProgram - child 2*Select the program that your child is enrolled inToddlerJunior Pre-KPre-KClassroom - Child 2Select which class your child is inRoom 1Room 2Room 3Room 4Room 5Room 6Room 7Room 8Add 3rd child who is enrolledyesno3rd Child InfoYour 3rd Child's Name* First Last Date of Birth - child 3* MM DD YYYYProgram - child 3*Select the program that your child is enrolled inToddlerJunior Pre-KPre-KClassroom - Child 3Select which class your child is inRoom 1Room 2Room 3Room 4Room 5Room 6Room 7Room 8Parent Contact InfoName of Parent/Guardian* First Last Relationship to Child*MotherFatherAuntUncleGrandmotherGrandfatherOtherOther relationship to childAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home Phone*Work Phone*Cell Phone*EmployerWould you like to add another parent/guardian contact?YesNoEnter Details for 2nd Parent/GuardianName of Parent/Guardian (2) First Last Relationship to Child (2)MotherFatherAuntUncleGrandmotherGrandfatherOtherOther relationship to child (2)Address (2) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email (2) Home Phone (2)Work Phone (2)Cell Phone (2)Employer (2)EMERGENCY Contact Name* First Last EMERGENCY Contact Email* EMERGENCY Contact Phone - Home*EMERGENCY Contact Phone - Work*EMERGENCY Contact Phone - Mobile*Terms & Conditions*By checking this box you agree to have your email address added to the EWECC mailing list. I agree.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.
