Membership - The Earth Day Kids Inc.

Name

This field is for validation purposes and should be left unchanged.

Student Name(Required)

First Last

Parent/Guardian Name

First Last

Parent/Guardian Email Address

Enter Email Confirm Email

Relationship to Student

Phone Number

Home Address

Street Address City State / Province / Region ZIP / Postal Code Country

Additional Parent/Guardian

Check this box if you would like to add a second parent/guardian.

Second Parent/Guardian Name

First Last

Second Parent/Guardian Email Address

Enter Email Confirm Email

Second Parent/Guardian Relationship to Student

Second Parent/Guardian Phone Number

Medical Information

Any allergies, medications, or medical conditions we should know about

Special Needs or Accommodations

Please describe any learning differences or special accommodations needed

Emergency Contact Information

Please provide name, relationship, and phone number

Photo and Media Release

Event photography and media permissions

I authorize the EDK to photograph/video my child for events, website, and promotional materials

I authorize the EDK to use my child's participation for educational displays

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