"*" indicates required fields Child's detailsChild's First Name * REQUIRED Child's Last name * REQUIRED Date of Birth * REQUIREDDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address * REQUIRED Address Line 1 Address Line 2 City ZIP / Postal Code School * REQUIRED Your decisions regarding your childDo you want to opt your child out of the NCMP? * REQUIREDPlease SelectYesNoPlease tell us why you would prefer your child not to be measured (optional)Would you like the results from the NCMP? * REQUIREDPlease SelectYesNoWould you like to opt out of the vision screening? * REQUIREDPlease SelectYes - my child is already under professional careYes - I do not want my child screenedNo - please include my childYour detailsYour Name * REQUIRED Your relationship to the child * REQUIREDPlease SelectParentCarerSpecial GuardianOther relativeOtherPhone number * REQUIREDEmail address * REQUIRED Email address Confirm Email Address CAPTCHA