Creative Kuponya Registration Form

Creative Kuponya Registration Form
Location: 149 Thompson Avenue East Suite 115 West Saint Paul, MN. 55075

Dates: January 17th ,January 24th , January 31st , and February 7th 2023

Time: Ages 9-13: 5:00-6:00pm

Ages 14-17: 6:30-7:30pm
Participant Details
Child 1 Full Name*

First Name Last Name
Age*
Session*
Date of Birth

MonthDay Year
Date
Child 2 Name

First Name Last Name
Age*
Date of Birth

MonthDay Year
Date
Session*
Parent Email*
example@example.com
Parent Phone Number*

Area Code Phone Number
Emergency Contact Person*

First Name Last Name
Emergency Person Phone Number*

Area Code Phone Number
Relationship to Emergency Contact Person*
T-shirt Size

XSSMLXLXXL
Date Signed

MonthDay Year
Date
Parent/Guardian Signature (If participant is below 18 years old)*

Clear
If applicable, other children that need to be registered
Should be Empty: