Kids Comedy Class Emergency Info Form
The information that you provide on this form will be used to ensure your child’s safe participation in programs at Arcade Comedy Theater. A completed form must be submitted prior to the start of camp in order for your child to participate.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Street Address *
Your answer
Street Address 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Primary Daytime Phone Number *
Your answer
Secondary Daytime Phone Number
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Additional Persons Authorized to Sign Student In/Out of Class
*If someone comes to pick up your child who is not on this list, please send a note at the start of class. Otherwise, we will contact you to come pick that child up.
Please list all names, separated by commas
Your answer
Students attending high school are able to sign themselves in/out without an authorized adult. Please mark below if your child is in high school and is authorized to sign him/herself into and out of class. *
Required
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