Live Oak Kids Registration Form: December 18th 2021

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Full Moon Nature Play Date
Saturday December 18th 10 am - 12 noon
Joaquin Miller Park
Ages 1- 4 yrs (under 12 mos can attend free with sibling)
Caregiver (up to 2 adults) must attend with child/children.
FREE

Registration fee includes: A magical moon themed morning in the woods with storytime, provided snacks, crafts and moon play.

Email *

Today's Date *

YYYY

Caregiver First and Last Name *

Caregiver Address *

Caregiver Phone Number *

Please list any other caregiver name(s) who may accompany your child to the group

How many children will you be enrolling between the ages of 1-4 years ? *

How many children under 12 months will you be bringing ? (Free if older sibling is enrolled).

Please list each child's First/Last Name, Date of Birth and Age, Preferred Pronoun (i.e. Sara Smith, 5/1/16, 5, she/her) *

Emergency contact Name and Phone Number (someone other than the caregivers who will attend the group) *

Please list any known allergies or food sensitivities

Please list any medical issues or developmental challenges we should be aware of

What are your child's interests, strengths and/or favorite activities ?

Please list an other pertinent information about your child here, or submit any other questions you may have about the group.

Thank you for your interest in this playdate! If there are still spots available you will receive a welcome packet and payment invoice to your email. See you in the woods !

A copy of your responses will be emailed to the address you provided.

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