Empower Registration
Child's First Name
*
Child's Last Name
*
2024-25 School Grade
*
-- None --
Nursery
PreK
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Date of Birth
*
Parent/Guardian Mobile Number
*
Parent/Guardian Email Address
*
Emergency Phone
*
Allergies
Peanuts
Almonds/tree nuts
Penicillin
Amoxycillin
Eggs
Milk
Other
Mailing Address
Mailing Address Line 2
Mailing City
Mailing State
Mailing Zip Code
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