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Wacky Wednesday Registration Form
This for will help us to ensure we have enough food and supplies for all kids who attend.
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* Indicates required question
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Parent's or Guardian's Last Name
*
Your answer
Parent's or Guardian's First Name
*
Your answer
Other Parent's or Guardian's Last Name
Your answer
Other Parent's or Guardian's First Name
Your answer
Address
*
Your answer
Best Phone Number to Reach You(xxx) xxx-xxxx
*
Your answer
Second Number in case of emergency(xxx) xxx-xxxx
Your answer
My child is:
*
Preschool age or younger and I will be attending with them.
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Does your child have any food allergies?
*
Yes
No
If you child has food allergies, what are they?
Your answer
If there anything special we should know about your child, please describe:
Your answer
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