Student name (required):
Elementary or middle school student attends (required):
Full home address including city and state (required):
Home ZIP code (required):
Parent or guardian name (required):
Parent or guardian telephone number (required):
Parent or guardian email address (required - we will email reminders to this address):
Additional emergency contact available during class hours:
Emergency contact name (required):
Emergency contact telephone number (required):
Allergy information:
Other medical or developmental information we should be aware of:
Demographic Information (required):
Please check all the dates you anticipate your child will be able to attend ECOS Nature Club.
Comments / How did you hear about us? Please be as specific as possible including location and name. (required)
We are committed to providing high-quality educational and workforce opportunities to motivated young people living in the urban neighborhoods served by the Kansas City Public Schools. Within this target population, we will not discriminate based on economic or social status, race, color, religion, sex, national origin, sexual orientation or physical disability.
We use the contact and personal information above only to communicate with families and ensure the safety of participants. We use non-identifying information for funder reports.
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