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Parent/Guardian 1

First Name

Last Name

Parent/Guardian 2

First Name

Last Name

Contact Phone #1

Contact Phone #2

Contact Email

Child Name

First Name

Last Name

Age as of Sept. 15, 2021

Child 2

First Name

Last Name

Age as of Sept. 15, 2021

Child 3

First Name

Last Name

Age as of Sept. 15, 2021

Child 4

First Name

Last Name

Age as of Sept. 15, 2021

How did you hear about us?

Can we photograph your child during this event? Images may appear online though no names or other direct info will be shared

Yes

No

Any allergies (food or otherwise), special needs or anything we may need to know to keep your child/children safe and have a great experience?

Additional People who have your permission to pick up your child/children from Kids Club?