2022-23 KIDS CLUB REGISTRATION FORM
Please complete one form for each child you want to enroll
Sign in to Google to save your progress. Learn more
Childs First Name *
Childs Last Name *
Child's Grade *
Child's Birthdate *
MM
/
DD
/
YYYY
Parents / Guardian Name *
Home Mailing Address *
Town *
Zip *
Best Contact Phone # *
2nd Contact Phone #
3rd Contact Phone #
Best Email  *
2nd Email
List of names who can pick up at Kids Club *
Child's Food Allergies
Insect or other Allegies
Any Medical Conditions our staff should be aware of:
(For example: Asthma, Diabetes etc)
Any Medications your child takes
Any other information our staff should know about your child.
You will be mailed several forms, 
we will need you to return the # 2, #3, and if you want # 4.
1. Parent Handbook
2.  Permission and Waiver Forms
3. Code of Conduct 
4. Credit Card Authorization Form
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy