Visioning Day Child Pre-Registration
Please Complete one survey for each child attending in your family
Parent(s)/Guardian(s) Full Name(s): *
Your answer
Parent/Guardian Contact Number *
Your answer
Program Affiliation (if applicable)
Your answer
Child's Full Name *
Your answer
Child's Age (minimum age 6 months) *
Your answer
Child's Gender
Your answer
Primary Language of parent/guardian *
Your answer
Does you child have ANY allergies (please list) *
Your answer
Does your child have a disability or any medical issues (please list and describe if so)
Your answer
There will be a photographer documenting this event. Is it okay to take photographs of your child? *
Is there anything else about your family or child that you would like us to be aware of?(likes/dislikes, behavioral issues, safety and security concerns, etc.):
Your answer
Is your child interested in participating in Zumba in the afternoon (7+)
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