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Busy Bees Registration
Busy Bees Club Registration Child’s Information
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Child’s Full Name
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Your answer
Date of Birth
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MM
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DD
/
YYYY
Age
*
Your answer
Gender
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Female
Male
School
*
Your answer
Home Address
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Your answer
Name of Mother/Guardian
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Your answer
Cell Phone
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Your answer
Email Address
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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
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Your answer
Emergency Contact Phone Number
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Your answer
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