40 Days Registration Form
PLEASE FILL OUT 1 FORM PER CHILD ATTENDING

Though not required, registering in advance will help make your drop off go more smoothly on the first day your child attends. We will have the form printed and ready for you to sign at check-in.

Child's Name (First & Last) *
Your answer
Grade *
Please note that children must have completed at least kindergarten in order to participate in the program.
Your answer
Parent / Guardian's Name (First & Last)
Your answer
Emergency Contact Number *
Your answer
Email
Your answer
Alternate Emergency Contact (Name & Number)
Your answer
Allergies
Your answer
Primary Transportation *
Indicate which will be the primary mode of transportation for your child to and from the program. If there is a change in plan, even for one day, please make sure to send a note or let the staff know at check-in for that day.
Reading Level *
Why are we asking this? For some activities, we will split the kids up by age, reading, and/or writing level to better tailor the program to each kid's needs.
Your answer
Writing Level *
Why are we asking this? For some activities, we will split the kids up by age, reading, and/or writing level to better tailor the program to each kid's needs.
Your answer
Is there anything else about your child you would like us to know?
Your answer
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