Kids' Connection Registration

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Kids' Connection Registration

* Indicates required question

Email *

Record my email address with my response

Parents' Names (First & Last) *

Your answer

Home Address *

Please include street address, city, and zip code.

Your answer

Primary Phone Number *

Please use the form 999-999-9999

Your answer

Email *

Your answer

Emergency Contact Name *

Your answer

Emergency Contact Relationship to children *

Your answer

Emergency Contact Phone Number *

Your answer

Additional people authorized to pick up children

Your answer

Child 1 Name *

Your answer

Child 1 Grade *

Choose

PK

K

1

2

3

4

5

6

Child 1 Allergies or Additional Comments

Your answer

Do you have additional children to register? *

Yes

No

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