KidsConnect Registration

Please fill out form below to register your child for KidsConnect. Child must be 4 – 12 years old to join the KidsConnect program.

Child's Information



Gender
MaleFemale

Parent/Guardian Information








Emergency Contact Information




Doctor Information




Approved Alternate Pick-up Person

I approve the following person to pick up my child

I am interested in receiving the EastRidge Monthly Newsletter and give express consent to receive it by email:

Yes, I give permission