Participation Information
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Email *
First and Last Name: *
Gender: *
Age: *
T-Shirt Size: *
School: *
Grade attended year 2018-2019: *
Home Address: *
City: *
State/Province: *
Postal/Zip Code: *
County: *
Telephone: *
(Include are code with telephone)
Parent Cell: *
(Include area code with cell phone)
Please list ADA Accommodations needed: *
(Please indicate N/A if not applicable)
Mother's name: *
Mother's day phone: *
Mother's cell: *
Father's name: *
Father's day phone: *
Father's cell: *
Drop Off/Pick up and Dismissal:
Drop off time: between 8:15 a.m. - 8:30 a.m.

Pick up time: between 4 p.m. - 4:15 p.m.
- A $1 fee will be charged for every minute late after a 10-minute courtesy wait.
Person's Authorized to pick up child: *
(Authorized person must bring identification in order to pick up child)
Other Dismissal Arrangements *
Emergency Contact Name: *
Emergency Contact Relationship: *
Emergency Contact Phone: *
Specify any of your child's health problems: *
(Please indicate N/A if not applicable)
Is your child on any medication? *
(If so, please specify)
Lunch and snacks will be provided however we recommend that children with specific dietary needs (i.e. food allergies, vegan, vegetarian, gluten-free, etc.) bring their own lunch and snacks. If you will be sending your child's lunch, please be sure that your child's lunch is clearly marked with your child's first and last name. Refrigerators and microwaves will not be available.
There is a $50 registration fee per student. Here is the link to submit each child's registration fee Each student must have a completed registration form.
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