LEGO Club 2023

Registration Form

Wednesday 3:45 - 4:45pm, April 5 - May 24, 2023 Age 10-12
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Allergies
Photo release permission*
Parent/Guardian signature
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
This program is geared for children ranging in age from 10-12 years old.

LEGO Club will be adhering to public health orders issued and will inform parents/guardians if there are any changes.
Should be Empty:

Registration Form