In case of Emergency contact (other than parents):Option AName: First Name* Last Name* Phone: Area Code* Phone Number*
Option BName: First Name Last Name Phone: Area Code Phone Number
Activity restrictions (mark with x): Yes No If Yes, please explain: Does your child(ren) have health insurance? (mark with x)Yes blanks No blankName Of Insurance Provider Phone number Area Code Phone Number Policy Number Child A
PHOTO RELEASE I * authorize Ciclo Sustainable Fashion to take pictures of my child which may be used in the future for Ciclo Sustainable Fashion advertisement, web content and publicity purpose.