Parent's/Guardian name *
Parent's/Guardian name
Home Address
Home Address
Home Phone *
Home Phone
Cell Phone
Cell Phone
Emergency Contact Person *
Emergency Contact Person
Emergency Contact Phone *
Emergency Contact Phone
If yes to participant covered by personal/family insurance, we are required to have the name of insurer, telephone number and policy or group number. *
If we do not receive name of insurer, telephone number, and policy or group number your application will not be processed and your child will not be able to participate until the information has been collected. Thank you for your cooperation.
Insurer Telephone Number *
Insurer Telephone Number *
Please include allergies, medical conditions and any necessary special instructions
Participant Agreement *
First Child
Child's name (1) *
Child's name (1)
Please register your child for the age he/she will be as of July 26, 2015
Child's birthday (1) *
Child's birthday (1)
In order to help us better serve your family's needs, please indicate whether your child(ren)'s information and photos need to be kept private.
Second Child
Child's name (2)
Child's name (2)
Please register your child for the age he/she will be as of July 26, 2015
Child's birthday (2)
Child's birthday (2)
In order to help us better serve your family's needs, please indicate whether your child(ren)'s information and photos need to be kept private.
Third Child
Child's name (3)
Child's name (3)
Please register your child for the age he/she will be as of July 26, 2015
Child's Birthday (3)
Child's Birthday (3)
In order to help us better serve your family's needs, please indicate whether your child(ren)'s information and photos need to be kept private.
Fourth Child
Child's name (4)
Child's name (4)
Please register your child for the age he/she will be as of July 26, 2015
Child's birthday (4)
Child's birthday (4)
In order to help us better serve your family's needs, please indicate whether your child(ren)'s information and photos need to be kept private.