Golden Sun Riding School After School Program Application:

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Child's Full Name *

Attending School *

Grade Level *

Child's Age *

Mother's Name *

Mother's Address (Include City and Zip Code) *

Mother's Occupation *

Father's Name *

Father's Address (Include City and Zip Code)
*

Father's Occupation *

Child resides with: *

Mother

Father

Both

Other:

Required

In case of emergency, if you are unavailable who should be contacted? *

Emergency contact phone number *

Emergency contact relationship *

Does your child have any allergies? If yes, please explain. If no respond N/A *

Does your child have any special needs we need to be aware of? If no respond N/A *

Does your child have any dietary restrictions? If no respond N/A *

My Child can be picked up by the following people: (Include relationship to child) *

Parent/Guardian Electronic Signature (First and Last name) *

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