RushKids Registration

Please complete and submit this form.

Parent/Guardian Name

*

Parent/Guardian Email

*

This address will receive a confirmation email

Parent/Guardian Cell Phone

*

Address

*

Spouse/Secondary Contact Name

Spouse/Secondary Contact Email

Spouse/Secondary Contact Cell Phone

Child Name

*

Birthdate

*

Age/Grade

*

Please select all that apply.

Nursery 2 year old 3 year old Preschool (4-5 year olds) Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade

Allergies

Child Name

Birthdate

Age/Grade

Please select all that apply.

Nursery 2 year old 3 year old Preschool (4-5 year olds) Kindergarten 1st 2nd 3rd 4th 5th 6th

Allergies

Child Name

Birthdate

Age/Grade

Please select all that apply.

Nursery 2 year old 3 year old Preschool (4-5 year olds) Kindergarten 1st 2nd 3rd 4th 5th 6th

Allergies

Child Name

Birthdate

Age/Grade

Please select all that apply.

Nursery 2 year old 3 year old Preschool (4-5 year olds) Kindergarten 1st 2nd 3rd 4th

Allergies

Child Name

Birthdate

Age/Grade

Please select all that apply.

Nursery 2 year old 3 year old Preschool (4-5 year olds) Kindergarten 1st 2nd 3rd 4th

Allergies

Description

Please complete and submit this form.

Please Fix the Following

Close