Kidz Central Registration
Reservation Name
*
First Name (This is the name that appears at the top of your reservation.)
Last Name
E-mail
*
example@example.com
Mother's Name
*
First Name
Last Name
Mother Cell Number
*
Mother E-mail
*
example@example.com
Father's Name
*
First Name
Last Name
Father Cell Number
*
Father E-mail
*
example@example.com
Please select your length of stay
*
Please Select
Sunday April 21st – Wednesday May 1st
Sunday April 21st – Sunday April 28th
Sunday April 21st – Thursday April 25th
Sunday April 21st – Friday April 26th
Thursday April 25th – Wednesday May 1st
Friday April 26th – Wednesday May 1st
Sunday April 28th – Wednesday May 1st
Number of Children
*
Please Select
1
2
3
4
5
6
7
8
9
10
Child 1 Name
*
Child 1 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 1 have any allergies?
*
Please Select
Yes
No
Child 1 Allergies
*
Please indicate if your child has ANY allergies.
Child 2 Name
*
Child 2 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 2 have any allergies?
*
Please Select
Yes
No
Child 2 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 3 Name
*
Child 3 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 3 have any allergies?
*
Please Select
Yes
No
Child 3 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 4 Name
*
Child 4 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 4 have any allergies?
*
Please Select
Yes
No
Child 4 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 5 Name
*
Child 5 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 5 have any allergies?
*
Please Select
Yes
No
Child 5 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 6 Name
*
Child 6 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 6 have any allergies?
*
Please Select
Yes
No
Child 6 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 7 Name
*
Child 7 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 7 have any allergies?
*
Please Select
Yes
No
Child 7 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 8 Name
*
Child 8 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 8 have any allergies?
*
Please Select
Yes
No
Child 8 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 9 Name
*
Child 9 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 9 have any allergies?
*
Please Select
Yes
No
Child 9 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Child 10 Name
*
Child 10 Age
*
Current Grade
*
Please Select
No School
Nursery 2
Nursery 3
Pre-K
Kindergarten/Pre-1A
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Does Child 10 have any allergies?
*
Please Select
Yes
No
Child 10 Allergies
*
Please indicate if your child has ANY allergies. If not applicable, please type N/A.
Additional Notes:
Submit
Should be Empty: