Kids Derby Day 2017
Lincolnwood Town Center’s 4th annual Kids Derby Day is coming up! Please use this form to sign your child up to participate. If you have multiple children participating, please fill out a separate registration for each child. Please sign up by no later than Thursday, April 6, 2017 at noon.

Date: Saturday, April 8, 2017

Time: 1-3pm (Please arrive at 12:30 to check-in)

Location: Center Court

Contact:
Michelle Lura White, Marketing Director, michelle.white@washingtonprime.com, 847-674-1219
Lauren Blake, Marketing Assistant, lauren.blake@washingtonprime.com

Parent/Guardian's First and Last Name
Your answer
Parent/Guardian's Email
Your answer
Parent/Guardian's Phone Number
Your answer
Child's Name
Your answer
Child's Age (As of April 8, 2017)
Your answer
Which Event Will Your Child Participate In?
If you have multiple children, please fill out a separate registration for each one.
How did you hear about Kid's Derby Day?
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