Healthy Living Seminar - Sept. 8th, 2019

Participant's Info:

This sections is about your child:

Name

Birthdate

Allergies or Special Needs?

Yes No

If yes, please explain:

Parent / Legal Guardian Info:

Guardian 1:

First Name

Last Name

Phone

This address will receive a confirmation email

Relationship to participant

Guardian 2:

First Name

Last Name

Phone

Relationship to participant

Alternate Pickup/ Emergency contact

First Name

Last Name

Phone Number

Relationship to paricipant

Description

9/8/19 -

Please fill out this form and click submit to register your child for childcare. One form must be completed per child.