Minor's Information
Full Name:
First Name
Last Name
Goes By Name:
Date of Birth (MM/DD/YYYY)
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Mes
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Día
Año
2 digit month, 2 digit day, 4 digit year
Fecha
Daycare/School Name and Grade for the 2026-2027 Academic Year:
Does this child have any allergies or medical Conditions AND are there any emergency medications required to be on site (e.g. inhaler, epi-pen)? Medications are to be provided by parent/guardian, in their original bottles, to the child's activity leader each time.
Insurance Provider and Policy Number
Is there any additional information that will be helpful to our providing the best possible care and experience for this child?
What size t-shirt does your child wear?
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