KIDS CLUB Parent Contact

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Childs Name

*

Child's Birthday

*

Grade

*

Please select one option.

Preschool Kindergarden 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Parents/Guardians Names

*

Email

*

This address will receive a confirmation email

Cell Phone

*

Home Address

*

Does your child have any allergies or medical conditions?

Please select all that apply.

Yes None

Please list all allergies and medical concerns

Does your child have permission to eat a snack in Kids Club?

*

Please select one option.

Yes No

Anything else you would like to share with us...

Description

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