Application Form

Please complete, and submit the form to register:

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Child’s Name

First

Last

Child’s Birth Date

Parent/ Guardians’ Name

First

Last

Parent Contact Informaion

Phone Number

Parent Contact Informaion

Email address

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Medical Information (e.g. allergies, medication requirements)

Days and Times of Attendance

Date

Time

Does your child have any special needs or accommodations?

Does your child have any dietary restrictions?

Is there any additional information you would like to share about your child or your family that would be helpful for us to know?