Name of Parent(s)/Guardian(s)*

    Parent's email*

    Other parent's email

    Parent's Cell Phone

    (XXX-XXX-XXXX)*

    Other Parent's Cell Phone

    (XXX-XXX-XXXX)

    Child 1 Name


    Child 1 Birthday

    (YYYY-MM-DD)

    Child 1 Grade

    Child 2 Name


    Child 2 Birthday

    (YYYY-MM-DD)

    Child 2 Grade

    Child 3 Name


    Child 3 Birthday

    (YYYY-MM-DD)

    Child 3 Grade

    Child 4 Name


    Child 4 Birthday

    (YYYY-MM-DD)

    Child 4 Grade

    Emergency Information

    Emergency contact person in event parents cannot be reached:

    Name


    Phone

    (XXX-XXX-XXXX)

    Relationship to child/family

    Medical

    Allergies

    Media

    We periodically take pictures and video for use online or in public places. We never print anyone names without written consent.