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Fall & Winter Club Registration
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* Indicates required question
Camper Name (First & Last)
*
Your answer
Birthday and Age
*
Your answer
Home Address, City, State, Zip Code
*
Your answer
Names of siblings in Kool Kidz Clubs
Your answer
Which Fall Club(s) are you registering for?
Fall Lego Club Age 6-8
Fall Lego Club Age 9-12
Fall Sewing Club
Fall Art Club
Option 5
Which Winter Club(s) are you registering for?
Winter Lego Club Age 6-8
Winter Lego Club Age 9-12
Winter Sewing Club
Winter Art Club
Winter Cooking Club
Parent or Guardian's Name
*
Your answer
Relationship to child
*
Your answer
Address (if different from child's), City, State, Zip Code
Your answer
Home Phone
*
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Email
*
Your answer
Second Parent or Guardian's Name
Your answer
Relationship to child
Your answer
Address (if different from child's), City, State, Zip Code
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Email
Your answer
Camper lives with
*
Your answer
Parental Status
*
Married
Divorced
Seperated
Single Parent
Camper is allowed to leave with (list anyone and everyone allowed)
*
Your answer
Emergency Contact Name (someone other than a parent or guardian)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Relationship to Camper
*
Your answer
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