• CLUBBER INFORMATION

    A separate form must be filled out for each child
  •  / /
    Pick a Date
  • TRANSPORTATION & AUTHORIZATION

  • Below you must list all individuals who will be authorized to Pick-Up your child from club.

    Please note: IF THEIR NAME IS NOT ON THIS LIST, THEY WILL NOT BE ABLE TO PICK UP YOUR CHILD.

  • The following individual is authorized to pick-up clubber:                        

  • The following individual is authorized to pick-up clubber:                 

  • The following individual is authorized to pick-up clubber:          

  • The following individual is authorized to pick-up clubber:                 

  • PARENT / GUARDIAN INFORMATION

  • MEDICAL INFORMATION

  • RELEASE & CONSENT

  • PLEASE READ AND INITIAL EACH OF THE FOLLOWING:

  • Clear
  •  / /
    Pick a Date
  •  
  • Should be Empty:
Jotform Logo
Now create your own Jotform - It's free!Create your own Jotform