top of page
Hand Hygiene

Registration Form

Registration

                        Family information  

         Custody  

Any custody restrictions?

         Emergency contacts  
Must differ from Parent or Guardians listed above

Please note that we require photo ID to authorize pick-up by anyone other than yourself. 

  Child's information

Gender
Is your child fully immunized?
Does your child have any allergies?
Does your child require any extra support or accomodations?
Gender
Is your child fully immunized?
Does your child have any allergies?
Does your child require any extra support or accomodations?
Gender
Is your child fully immunized?
Does your child have any allergies?
Does your child require any extra support or accomodations?
What program are you signing up for?
Preferred days

Thank you for submitting!

bottom of page