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Wednesday Night Kids Clubs
Event Timing: Begins September 8th ( 6:30pm-8:15pm)
Event Address: 1300 17th ave w, Bradenton, FL 34205
Contact us at (941) 749-0288 or
info@experiencecitylife.com
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* Indicates required question
Email
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Your email
Parent/Guardian Name
*
Your answer
Primary Contact Phone Number
*
Your answer
Child's Name
*
Your answer
Gender
*
Male
Female
Child's Grade
*
Choose
Pre -K ( 3,4,5, not in Kindergarten )
K- 1st
2nd -3rd
4th - 5th
6th-8th
T-Shirt Size
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Choose
XS
S
M
L
XL
Medical Conditions / Allergies
*
Yes
No
If Yes to Medical / Allergies, Please explain
*
Your answer
Emergency Contact Information ( Phone Number)
*
Your answer
I Give Permission for the following people to pick my child up, if I cannot.
*
Your answer
Medical Release : I give permission for my child to be treated by medical personnel in case of an emergency.
*
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Required
By participating in this program I understand that City Life will capture photos and videos of my child for awards slideshows, social media and marketing.
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