Paleo Play / CHE Registration FALl 2019
Child's FIrst Name *
Your answer
Child's Last Name: *
Your answer
Child's Age: *
Your answer
Parents/Legal Guardian Name(s): *
Your answer
Phone Number (daytime): *
:
Your answer
Alternative/Emergency Phone Number: *
Your answer
Street Address: *
Your answer
City/Town: *
Your answer
Postal Code: *
Your answer
Email Address: *
Your answer
Does your child have any allergies/medical conditions? *
If yes, please specify
Your answer
Will you permit photos and/or video to be taken of your child and displayed and/or used for promotions by Paleo Play? Note: Child's name will NOT be used. *
Please make sure to fill out your Medical + Waiver forms (included in the email that had link to this form). *
Indicate below how you will be returning your forms.
Which Program are you registering for?
Please indicate your method of payment: *
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