Registration
2025/ 2026 Year
Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My child's photo may NOT be used for promotions and slide shows
My child's photo may be used for promotions and slide shows
My child's photo may be used for internal slideshows only
Number of children registering
Child 1
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Class/Grade
Wiggly Worms (under 2)
Busy Bees (2-3 yrs olds)
Pre-K (4-5 yrs old)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Does your child need a NEW shirt? Pre-K to 5th grade only
Yes
No
If yes, indicate T-Shirt size
Please Select
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 2
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Class/Grade
Wiggly Worms (under 2)
Busy Bees (2-3 yrs olds)
Pre-K (4-5 yrs old)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Does your child need a NEW shirt? Pre-K to 5th grade only
Yes
No
If yes, indicate T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 3
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Class/Grade
Wiggly Worms (under 2)
Busy Bees (2-3 yrs olds)
Pre-K (4-5 yrs old)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Does your child need a NEW shirt? Pre-K to 5th grade only
Yes
No
If yes, indicate T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 4
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Class/Grade
Wiggly Worms (under 2)
Busy Bees (2-3 yrs olds)
Pre-K (4-5 yrs old)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Does your child need a NEW shirt? Pre-K to 5th grade only
Yes
No
If yes, indicate T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 5
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Class/Grade
Wiggly Worms (under 2)
Busy Bees (2-3 yrs olds)
Pre-K (4-5 yrs old)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Does your child need a NEW shirt? Pre-K to 5th grade only
Yes
No
If yes, indicate T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 6
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Class/Grade
Wiggly Worms (under 2)
Busy Bees (2-3 yrs olds)
Pre-K (4-5 yrs old)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Does your child need a NEW shirt? Pre-K to 5th grade only
Yes
No
If yes, indicate T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Section Registration
New T-shirt Fee
*
prev
next
( X )
Number of new T-shirts (per child PreK to 5th grade)
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Submit
Should be Empty: