Online Registration Form for Parents and Guardians for Parent and Child Nights (PAC)

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* 1. Name of your child

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* 2. Parent/Guardian Name

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* 3. Date of Birth (DOB) and Age of your child

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* 4. Does your child have any allergies? If yes, please specify

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* 5. Is sibling care needed?

Yes

No

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* 6. If so, what is the age and name of the sibling?

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* 7. Phone Number

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* 8. Email Address

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* 9. Home Address

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* 10. Do you consent to have photoes taken of your child during PAC and potentially posted on Ellsworth Community School Districts social media?

Yes

No