Children's Registration Form

My child will be attending:
Saturday Kids Program 5-12 year olds (Saturday 9am - 12:30pm, $10)
Details
Name of Child:	*
Date of Birth:	*
Address:	*
Parent/Guardian:
Phone:
Emergency Contact
Name:	*
Relationship with Child:	*
Phone:
Medical Information
Please list any medical information / allergies or medication needed:
Comments:
	* = required