Block Party Summer Kick Off

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Email *

Block Party Summer Kick Off

Child's First and Last Name *

Child's Age *

Child's Birthday *

YYYY

Child's Current Grade Level *

Child's School *

Parent First Name *

Parent Last Name *

Parent Cell Phone *

Parent Address *

Parent Email *

Please indicate any allergies your child has. If none, please indicate by responding NONE. *

Emergency Contact Name *

Emergency Contact Cell *

Block Party Summer Kick Off *

May 17 - 3:30 to 5:00

I agree to register my child for the classes selected. I understand no refunds or credits will be given for missed classes. An invoice will be emailed to you upon submitting this registration.

Yes

Required

I give permission to allow my child to be photographed and to allow any pictures in which my child appears to be released for publication in newspapers, brochures, for fundraising or public relations.

Yes

I give permission to seek emergency medical treatment for my child in the event that I cannot be reached.

Yes

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

Submit

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