Registration & Health Info
Email *
Name of Student: *
Parent/Guardian Name(s): *
Address: *
Primary Phone Numbers: *
Work Phone Numbers: (If student is with us while parent is working) *
Primary E-mail: *
Emergency Contact Name *
Emergency Contact Number *
T-Shirt Size *
Grade student was in 2020-2021 *
My child has the following physical condition that may require special attention: *
Required
Types of Allergies (If applicable):
Please list any additional physical conditions that leaders should be aware of:
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