Franc-O-Fun Registration Form
Student
Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Birthdate *
Your answer
Grade *
Your answer
Home Phone *
Your answer
Status *
Experience
Your answer
Parent
Name *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
E-Mail *
Your answer
Medical
Dr. Name *
Your answer
Phone *
Your answer
Medical Conditions
which may require attention, ie. allergies, medications, physical impairment
Your answer
Emergency Contact
In case of an emergency, please notify:
Name *
Your answer
Phone *
Your answer
Address *
Your answer
Classes
Class 1 *
Location *
Day *
Your answer
Time *
Your answer
Class 2
Location
Day
Your answer
Time
Your answer
Class 3
Location
Day
Your answer
Time
Your answer
Class 4
Location
Day
Your answer
Time
Your answer
Extra Questions
How did you hear about us?
Comments
Your answer
By Filling out this Regisration Form and clicking the "Submit" button you are giving permission for your child to participate in Franc-O-Fun LLC. classes and you agree that Franc-O-Fun LLC. is not responsible and may not be held liable if your child has an injury during the time he/she is at class.
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This form was created inside of University of Connecticut.