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.