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Kid City is hosting a Cartwheel-a-thon fundraiser to finish our growing areas! Our wish list includes ninja warp wall and Pitt area, updating bathrooms, sensory play area for our special needs community, finishing the outside area for our after school and mom's morning out programs and installment of new carpet in birthday party room and front office area.

Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)*

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)
	School:*	Grade Level:*
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

Questions/Options:


Please list the student you are sponsoring for the Cartwheel-A-Thon
Please list amount of donation

Additional Information: