Leave this field empty

ELC First Aid and Emergency Medical Care Consent Form

Please note: ALL fields are required. Please list both parents, if applicable, and at least one other person. Please type in "N/A" for fields not used.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

For added Security please check the box below.