Innovation Playground Contact Info
Parents- please fill out this form so that we have the important contact & health info for your child! Our contact info: Fred Jaravata: 415-297-0163 Sharon Jaravata: 415-271-9665

Returning students do not have to fill this out as we have your information already--thanks!

Email address *
Name of Student 1 *
Your answer
Grade Level of Student 1 *
Your answer
Name of Student 2
Your answer
Grade Level of Student 2
Your answer
Name of Student 3
Your answer
Grade Level of Student 3
Your answer
Parent / Guardian 1- Full name *
Your answer
Parent / Guardian 1- Email *
Your answer
Parent / Guardian 1- Phone # *
Your answer
Parent / Guardian 2- Full name
Your answer
Parent / Guardian 2- Email
Your answer
Parent / Guardian 2- Phone #
Your answer
Please check off your chosen dates and times. You will pay per class, so if the date has already passed, then you are registered for future subsequent dates. *
Required
Are there any Allergies/Medical Conditions/Disabilities we should be aware of? *
All information is CONFIDENTIAL, if you have more than one child, please be clear about WHO has WHAT conditions.
Your answer
List emergency contact who can pick your child up *
Name, Phone #, Relationship
Your answer
Are you able to BYOD (bring your own device)? *
Other comments and/or names and grade levels of additional registered children
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service