Busy Bees Registration
Busy Bees Club Registration Child’s Information
Child’s Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
School *
Your answer
Home Address *
Your answer
Name of Mother/Guardian *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Name of Father/Guardian *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Emergency Information Person(s) Authorized to Pick Up Your Child or to be Notified in an Emergency: The staff will not allow your child to leave with anyone who is not listed on this form.
Emergency Contact 1 *
Your answer
Emergency Contact Phone Number *
Your answer
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