Paleo Play / Earth Skills Program Registration Spring 2018
Email address *
Child's First Name: *
Your answer
Child's Last Name: *
Your answer
Child's Age:
Your answer
Which program are you registering for? *
Required
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
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? *
We will not publish childrens' names with 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. *
Fee: $60/session or $240 for all four sessions (4 Saturdays)
A copy of your responses will be emailed to the address you provided.
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