Child Registration

Please fill out this form to register your child for activities.

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Child's Name *

First

Last

Child's Age *

Child's Gender *--- Select Choice ---MaleFemale

Child's Street Address *

Parent or Guardian's Name *

First

Last

Phone Number *

Email *

Please list any food allergies or other health concerns we should be aware of for your child. *

Primary Emergency Contact Name *

First

Last

Primary Emergency Contact Phone Number *

should for list

Secondary Emergency Contact Name *

First

Last

Secondary Emergency Contact Phone Number *

Submit