Adoption Support Alliance Kids Club
Please complete the form below to register for The Kids Club scheduled for July 18 through 22, 2016. Cost of the program will be $150 from 9 am until noon (for ages 5 to 11) and 2 pm until 5 pm (for middle school). In response to feedback from families, we have expanded the hours from our original plans. If the cost is problematic, please let us know and we will work with you!
Child's Name
Your answer
Parents Name
Your answer
Address
Your answer
Phone Number
Your answer
Email Address
Your answer
Child's Date of Birth
Your answer
Child's Gender
Type of Adoption
Please check all that apply to your child's adoption.
Required
What other information do you feel is important for us to know concerning your child that will help make the Kids Club a better experience for him or her?
Your answer
Are there any behavior issues that we should be aware of?
Your answer
Does your child have any food allergies? If so, which foods?
Your answer
Emergency Contact
Your answer
Emergency Contact Phone Number
Your answer
How did you learn about The Kids Club?
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