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Children from Kindergarten - 6th grade

Child's Name *
Child's Name
If you have more than 1 child to register, please fill out each form separately.
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
(street address, city, state, & zipcode)
Contact Info
Primary Phone Contact *
Primary Phone Contact
Secondary Phone Contact
Secondary Phone Contact
Child Info
Birth Date *
Birth Date
example: 02 19 1990
Please include any food allergies
Emergency Contacts
(other than listed above)
Primary Contact Phone *
Primary Contact Phone
Secondary Contact Phone *
Secondary Contact Phone
Dismissal Information
Other Information
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion?