JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Creative Clubhouse Summer Program 2024
Please note, school age is full for Tuesdays and Thursdays!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Birth date
*
MM
/
DD
/
YYYY
Address
*
Your answer
Parent/Guardian #1
*
Your answer
Parent #1 Phone
*
Your answer
Parent #1 Email
*
Your answer
Parent/Guardian #2
Your answer
Parent #2 Phone
Your answer
Parent #2 Email
Your answer
Emergency Contact #1 Name and Phone
*
Your answer
Emergency Contact #2 Name and Phone
*
Your answer
Persons authorized to pickup name and number
*
Your answer
Medical care name, number, and address
*
Your answer
Dental care name, number, and address
*
Your answer
Any medical concerns, allergies, dietary needs, etc.
*
Your answer
This summer breakfast and snack will be provided. To help us understand the quantities in demand, please indicate if your child will typically have breakfast:
*
Provided breakfast
Breakfast prior to arrival
Child's shirt size
*
Youth XS
Youth S
Youth M
Youth L
Youth XL
Other:
Child's current grade (Spring 2024)
*
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
Next
Page 1 of 6
Clear form
Never submit passwords through Google Forms.
This form was created inside of Nativity Of Mary School.
Report Abuse
Forms
