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Starshine Birthday Party Registration Form
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* Indicates required question
Birthday Kid name (first, last)
*
Your answer
Participant preferred pronouns
*
she/her/hers
he/him/his
they/them/theirs
Other:
Participant Birthday
*
MM
/
DD
/
YYYY
# of kiddos expected to join the party
*
Your answer
Preferred Party Location
*
The Suttle Lodge
Other:
If you selected "other" for your party location, what is the address location?
*
Your answer
Parent/Guardian name (first, last)
*
Your answer
Parent/Guardian preferred pronouns
*
she/her/hers
he/him/his
they/them/theirs
Other:
Parent/Guardian email
*
Your answer
Parent/Guardian phone
*
Your answer
Emergency contact name
*
Your answer
Emergency contact phone
*
Your answer
Please list any medical, social, emotional, or learning conditions of any of the participants that are relevant for the instructor to know in order to keep the participant safe, as well as, design an appropriate program suited to their needs?
*
Your answer
How did you find out about Starshine?
Your answer
Would you like to sign up for email updates from to learn about future Starshine opportunities?
Yes
No
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