Wildfire Children's Clinic Registrations
* Required
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Grade in 2019-2020
*
Not yet in Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Guardian's Name
*
Your answer
Guardian's Phone#
*
Your answer
Guardian's Email Address
*
Your answer
Food Allergies
Your answer
I will get my payment to the Wildfires:
*
By mailing it to Angela Dolezal at PO Box 127, Lindsborg, KS 67456.
By bringing it to the dance clinic on July 2nd.
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