Kids Summer Clubhouse (ages 4-12)
Event Timing: Every Tuesday in July, starting July 9th
Time: 11am-1pm
Event Address: 11102 Sunrise Blvd. E., Suite 112 Puyallup, WA 98374
Contact us at 253.200.0944 or office@thetearsfoundation.org

*If more than one child will be attending, please fill out a form for each individual child*

Email address *
Parent/ Legal Guardian name *
Your answer
Phone number *
Your answer
Email *
Your answer
Child's Name that will be attending *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Gender *
Your answer
Name of sibling attending in honor of: *
Your answer
Anything your child would like to share with us about the sibling they have lost:
Your answer
Special considerations and/ or concerns:
Your answer
What days will you and your child attend? *
Required
Dietary restrictions
Your answer
I understand that the child's parent or guardian will have to remain on the premises during Summer Clubhouse *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of The TEARS Foundation. Report Abuse - Terms of Service