KSB- Kids Summer Blast
Please provide basic information, medical details, emergency contacts, and acknowledge the waiver.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Allergies (please list any allergies your child has)
Medical Conditions (please list any relevant medical conditions)
Secondary Emergency Contact Name
*
First Name
Last Name
Secondary Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Images
Child's grade in the fall
1st
2nd
3rd
4th
5th
6th
Event requirements
Consent for photo/video release
*
Yes
No
Register
Should be Empty: