SUMMER FUN REGISTRATION
<br>
<br>Child’s Name ____________________________ Age ________ Birth Date _________
<br>Address ___________________________________ Home Phone_____________________
<br>Parent/Guardian ________________________ Work Phone _______________________
<br>Emergency Contact (other than parent)______________________________________
<br>Brief medical history (allergies, physical impairments, or any other information you feel may be helpful).
<br>___________________________________________________________________________
<br>___________________________________________________________________________
<br>Days attending: ___ Mon ___ Tues ____ Wed ____Thurs ____ Fri 
<br>Arrival Time_________ Departure Time _________ Full Time _______ 
<br>Part Time ____