Storytime Explorers Registration Form
Participant Last Name *
Your answer
Participant First Name *
Your answer
Participant Address *
Your answer
Participant City *
Your answer
Participant Zip Code *
Your answer
Parent Guardian Name (First, Last) *
Your answer
Parent/ Guardian Address
If different from student
Your answer
Parent/ Guardian E-Mail *
Your answer
Home Phone Number *
xxx-xxx-xxx
Your answer
Cell Phone Number *
xxx-xxx-xxx
Your answer
Student Age *
How old will the participant be this August?
Your answer
Does your son or daughter have any allergies, medical conditions or either physical or behavioral challenges ? *
Please list anything you feel our teachers should be aware of, or simple type "none".
Your answer
How did you hear about this program? *
Past participant, friend recommendation, newspaper, our website, online camp listing, flyer etc.
Your answer
NEW - Referral Discount - Refer a friend now and pay only $150 if they register too!
Last Name of Friend or Sibling
Your answer
First Name of Friend or Sibling
Your answer
Friend's parent/guardian E-mail
Your answer
Friend's parent/guardian Phone Number
xxx-xxx-xxxx
Your answer
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