Parent / Guardian *
Parent / Guardian
Address *
Address
Phone *
Phone
Emergency Contact *
Emergency Contact
(other than listed above)
Phone Number *
Phone Number
Emergency Contact *
Emergency Contact
(other than listed above)
Phone Number *
Phone Number
Child 1 *
Child 1
Birthday *
Birthday
Medical or other information we need to know (Please include any food allergies)
Child 2
Child 2
Birthday
Birthday
Medical or other information we need to know. (Please include any food allergies.)
Child 3
Child 3
Birthday
Birthday
Medical or other information we need to know. (Please include any food allergies.)
Child 4
Child 4
Birthday
Birthday
Medical or other information we need to know. (Please include any food allergies.)
Please provide: Name, Birthday, Last grade completed in school, Medical Information.
May we have permission to photograph your child? *
(choose one)
May we have permission to use your child's photograph for the purpose of promotion? *
(choose one)