Registration Form (One Per Child)

Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Address
Address
Name of parent or guardian *
Name of parent or guardian
Contact Phone Number *
Contact Phone Number
Emergency/Medical Information
Emergency Contact Name (if other than above)
Emergency Contact Name (if other than above)
Emergency Contact Phone Number (if other than above)
Emergency Contact Phone Number (if other than above)