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Lions Special Kids Day Reservation Form
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* Indicates required question
Registrant Name
*
Parent/Agency/Caregiver
Your answer
Registrant Address
*
Parent/Agency/Caregiver
Your answer
Registrant City Zip
*
Parent/Agency/Caregiver
Your answer
Registrant E-Mail
*
Parent/Agency/Caregiver
Your answer
Registrant Phone
*
Parent/Agency/Caregiver
Your answer
Attendee Name
*
Attendee with special needs
Your answer
Attendee Age
*
Attendee with special needs
Your answer
Name(s) of Siblings Attending
Sibling Name(s)
Your answer
Age(s) of Siblings Attending
Sibling Age(s)
Your answer
Number of Parent(s)/Caregiver(s) Attending
*
Number of parents/caretakers attending
Your answer
Which school (or organization) does child attend?
Which school (or organization) does child with special needs attend
Your answer
Please bring a signed copy of the waiver form with you!
https://www.lionsspecialkidsday.com/guest-info-sign-up
Please input your name here to indicate that you have read and signed the waiver.
*
Your answer
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