Kids S.E.E. Sign Up Form

Kids S.E.E. Sign Up Form
Guardian Name*

First NameLast Name
Guardian Email*
example@example.com
Guardian Phone Number*
Please enter a valid phone number.
Child's Name*

First NameLast Name
Child's Birthdate*

MonthDayYear
Date
Last Grade Completed*
People authorized to pick up your child.
List any allergies.
Do vou wish to give permission to the Round Top Family Library to use photos/videos taken of vour child during this program for media purposes?*

YesNo
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
Any additional emergency contact details.
By checking this box, you acknowledge that you are the legal quardian of the child for whom you are submitting this form.*
Select the month you would like to sign up for:*