Check-In Registration

Purpose of Registration *

First Time Visitor

Updating Information

Are you the Parent of the child you are registering? *

Yes

No

Parent 1 First Name

Parent 1 Last Name

Phone Number

Email Address

Date of Birth

Parent 2 First Name

Parent 2 Last Name

Phone Number

Email Address

Date of Birth

Relationship to child(ren)

First Name

Last Name

Phone Number

Email

Date of Birth

Street Address

City

State

Zip Code

How would you like us to update your profile?

How many children will you be registering?

Names of Children

Child 1 Full Name

Gender

Date of Birth

Current Grade Level *

Special Needs / Food Allergies / Medical Notes

Child 2 Full Name

Gender

Date of Birth

Current Grade Level *

Special Needs / Food Allergies / Medical Notes

Child 3 Full Name

Gender

Date of Birth

Current Grade Level *

Special Needs / Food Allergies / Medical Notes

Child 4 Full Name

Gender

Date of Birth

Current Grade Level *

Special Needs / Food Allergies / Medical Notes

Child 5 Full Name

Gender

Date of Birth

Current Grade Level *

Special Needs / Food Allergies / Medical Notes

Additional Notes (Custody situations, etc)

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