Email *EmailConfirm EmailParent 1 *Parent 1 First & Last Name (Padre 1 Nombre y Apellido)Phone #1 *(###)###-####Parent 2 Parent 2 First & Last Name (Padre 2 Nombre y Apellido)Phone #2 (###)###-####Emergency Contact #1 *Name and phone number (Emergencia Nombre y número de teléfono)Emergency Contact #2 Name and phone numberIn case of emergency, or in the event I cannot be reached to make arrangements for emergency care, I authorize the person in charge to take my child to: *YesCook Children’s Hospital, 886 6th Ave., Fort Worth, TX 76104The nearest emergency care facilityNoEn caso de emergencia, o en caso de que no puedan localizarme para hacer los arreglos para la atención de emergencia, autorizo a la persona a cargo a llevar a mi hijo a:Does your child(ren) have any allergies or food restrictions (¿Su(s) hijo(s) tiene(n) alergias o restricciones alimentarias?) *YesNoIf you answered yes please list all allergies, restrictions and medications (Si respondió que sí, enumere todas las alergias, restricciones y medicamentos) Please list all allergies, restrictions and medications (Enumere todas las alergias, restricciones y medicamentos)Child #1 Child #1 First & Last Name (Niño #1 Nombre y Apellido)Child #1 Date of Birth Child #1 Date of Birth (Niño #1 Fecha de nacimiento)Child #1 Grade Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeChild #1 Grade (Next School Year) (Niño #1 Grado (Próximo año escolar))Child #2 Child #2 First & Last NameChild #2 Date of Birth Child #2 Date of BirthChild #2 Grade Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeChild #2 Grade (Next School Year)Child #3 Child #3 First & Last NameChild #3 Date of Birth Child #3 Date of BirthChild #3 Grade Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeChild #3 Grade (Next School Year)Child #4 Child #4 First & Last NameChild #4 Date of Birth Child #4 Date of BirthChild #4 Grade Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeChild #4 Grade (Next School Year)WebsiteSubmit
