Paleo Play / AfterSchool Program Registration / Spring 2022
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Email *
Child's First Name: *
Child's Last Name: *
Child's Age:
Which program are you registering for? *
Parents/Legal Guardian Name(s): *
Phone Number (daytime): *
Alternative/Emergency Phone Number: *
Street Address: *
City/Town: *
Postal Code: *
Does your child have any allergies/medical conditions? *
If yes, please specify
Will you permit photos and/or video to be taken of your child and displayed and/or used for promotions by Paleo Play? *
We will not publish childrens' names with any images.
Please make sure to fill out your Medical + Waiver forms (which you will receive via email) *
Indicate below how you will be returning your forms.
Please indicate your method of payment. *
FEES:     :  [ 5 sessions x $40/day = $200 ]        
A copy of your responses will be emailed to the address you provided.
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