2018-2019 Kids' Club Registration
Begins September 30, 2018 at 6pm | Please fill out this form and click submit.
Parent/Guardian Name
*
Email
*
This address will receive a confirmation email
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Number at which you can be reached in the event of an emergency or in the case of inclement weather:
*
Can we text you at this number?
*
Please select one option.
Yes
No
Are you willing to help out in Kids' Club?
*
Please select one option.
YES! Please contact me
No, not at this time
Child 1 Name
*
Child 1 Age
*
Please select one option.
4 (by Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Select Option
4 (by Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Child 1 Grade
*
Please select one option.
Pre-K
K
1
2
3
4
5
6
Select Option
Pre-K
K
1
2
3
4
5
6
Please list any allergy of relevant health information for Child 1
Child 2 Name
Child 2 Age
Please select one option.
4 (as of Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Select Option
4 (as of Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Child 2 Grade
Please select one option.
Pre-K
K
1
2
3
4
5
6
Select Option
Pre-K
K
1
2
3
4
5
6
Please list any allergy of relevant health information for Child 2
Child 3 Name
Child 3 Age
Please select one option.
4 (as of Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Select Option
4 (as of Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Child 3 Grade
Please select one option.
Pre-K
K
1
2
3
4
5
6
Select Option
Pre-K
K
1
2
3
4
5
6
Please list any allergy of relevant health information for Child 3
Child 4 Name
Child 4 Age
Please select one option.
4 (as of Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Select Option
4 (as of Sept 1, 2018)
5
6
7
8
9
10
11
12
13
Child 4 Grade
Please select one option.
Pre-K
K
1
2
3
4
5
6
Select Option
Pre-K
K
1
2
3
4
5
6
Please list any allergy of relevant health information for Child 4
Submit
Description
Begins September 30, 2018 at 6pm
Please fill out this form and click submit.
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