CANDY COLORS PLAYDATE

1
Student’s Name* This field is required.
2
Nickname* This field is required.
3
Birthday* This field is required.
Date
Year
Month
Day
4
Age* This field is required.
5
Complete Address* This field is required.
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Large
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Small
Ok
Ok
6
Current Level (if applicable)* This field is required.
7
Last School Attended (if applicable)* This field is required.
8
Mother's Name* This field is required.
First Name
Last Name
9
Contact Number* This field is required.
10
Father's Name* This field is required.
First Name
Last Name
11
Contact Number* This field is required.
12
Emergency Contact Name* This field is required.
First Name
Last Name
13
Facebook Acct Name
First Name
Last Name
14
Contact Number* This field is required.
15
Email Address* This field is required.
16
Authorized Pick Up Person
First Name
Last Name
17
Relation to Student
18
Does your child have any medical conditions the school should know about? If yes, please provide details.* This field is required.
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Large
Normal
Small
Ok
Ok
19
Is your child asthmatic? If yes please provide details (triggers, medication, instruction)* This field is required.
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Small
Ok
Ok
20
Does your child have any allergies? please specify* This field is required.
21
During the playdate, photos and videos may be taken for documentation and school-related purposes* This field is required.
YES, I give permission for my child’s photos/videos to be posted on the school’s official social media, and marketing materials.
NO, I do not give permission for my child’s photos/videos to be posted publicly.
22
I confirm that the information provided above is true and correct. I understand and agree to the school guidelines, including the non-transferable and non-refundable policy.
First Name
Last Name
Should be Empty: