In The Wild Registration
Fill out the form below to register for "In The Wild" Kid's Adventure Nights, on July 1-5th 2019 at 6:30-8:45pm
Name *
Your answer
Email Address *
Your answer
Birthdate (please change the yr) *
MM
/
DD
/
YYYY
Grade Completed *
Your answer
Parent's Name
Your answer
Phone Number
Your answer
In case of emergency: The parents/guardians named here, authorize the staff of Kid's Adventure Nights to consent for medical treatment and to authorize a physician or hospital to provide medical assessment, treatment or procedures for the child named here if the parent/guardians are unreachable *
Required
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