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Top Secret Pen Pal Group Registration
Thank you for your interest in the Top Secret Pen Pal group! Kidable's groups are hosted by pediatric occupational therapy professionals to enhance functional skills in a fun environment. For optimal individualized attention, these groups are kept small.
Completion of this form does not guarantee registration. Registration is complete once payment is received.
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Email
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Your email
I confirm I am registering my child for the Top Secret Pen Pal Group, which costs $215 and is hosted at the CoLab in downtown Grandin on Saturdays from 10:30-12:00 from October 8th to November 12th.
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Yes, that's the plan
Required
Full Name of Participant
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Your answer
Participant's Age
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Your answer
Participant's Birthday
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MM
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DD
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YYYY
Participant's Preferred Pronouns
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he/him
she/her
they/them
Other:
Home Address (Street, City, State, Zip)
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Your answer
Name of Caregiver (1)
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Your answer
Phone Number for Caregiver (1)
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Your answer
Email for Caregiver (1)
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Your answer
Name of Caregiver (2)
Your answer
Phone Number for Caregiver (2)
Your answer
Email for Caregiver (2)
Your answer
Name of Emergency Contact (if caregiver(s) cannot be reached)
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Your answer
Phone Number for Emergency Contact
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Your answer
Emergency Contact's Relationship to Participant
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Grandparent
Aunt/Uncle
Family Friend
Babysitter
Other:
Required
Please list the names and phone numbers of anyone approved to pick up or drop off the child to the group.
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Your answer
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