MCF Kid Check Registration

Date

Your Information

Name

This address will receive a confirmation email

Phone

Address

Mailing Address, if different than above

Receiving Text Messages

May we send you text messages?

Yes No

"We occasionally send convenient text message reminders and alerts to our membership. Message and data rates may apply. To opt-out of those messages at any time, reply with STOP and you will be removed from all messaging. For further information, visit breezechms.com/terms-of-service."

Child's / Children's Information

Please provide each child's name, their gender, their date of birth, their age or grade in school (if applicable) and any allergies and/or medical concerns.

1st Child's Information

Child's Name

Child's Gender

Child's Date of Birth

Allergies (Please leave blank if none)

Medical Concerns (Please leave blank if none)

2nd Child's Information

Child's Name

Child's Gender

Child's Date of Birth

Allergies (Please leave blank if none)

Medical Concerns (Please leave blank if none)

3rd Child's Information

Child's Name

Child's Gender

Child's Date of Birth

Allergies (Please leave blank if none)

Medical Concerns (Please leave blank if none)

4th Child's Information

Child's Name

Child's Gender

Child's Date of Birth

Allergies (Please leave blank if none)

Medical Concerns (Please leave blank if none)

Other information we may need to know:

MCF Kid Check Registration

Description

Please Fix the Following