Registration

Note: *We kindly request you fill out the requested details below and agree to our Waiver Release Form.

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*

Questions/Options:


Do any of your children have any physical limitations or injuries you need to inform us about?*
If you answered yes to the above question, please explain here. If your answer was no, please type NA.*
Do any of your children have any emotional or behavioral concerns or accommodations needed?*
If you answered yes to the above question, please explain here. If your answer was no, please type NA.*

Additional Information:

Parent/Guardian Participant Release

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