First Name of parent or guardian

last Name of parent or guardian

Email

Phone Number

First Name of Child

Last Name of Child

How old is your child?

Does your child have allergies, food restrictions, or medications? Does your child have allergies, food restrictions, or medications? Yes No

What allergies does your child have including, food restrictions or medications?

First and last names of emergency contact

Phone number of emergency contact

First and last names of pickup contact

Phone number of pickup contact

Please enter any other relevant info, such as if your child is only attending specific days, or if you do not consent to have your child photographed

Please enter your initials to confirm that the information you provided above is accurate and that you have read and agreed to the conditions below