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CHILD'S NAME - (THE NAME THEY PREFER) -

GRADE JUST COMPLETED -

AGE -

FOOD ALLERGIES -

ANY FEARS OR ANYTHING WE NEED TO KNOW ABOUT FOR THE DAY-

DO THEY KNOW ANYONE FROM LRBC? WHO INVITED THEM (Prize Purposes)

EMERGENCY CONTACT -

BEST PHONE # IN CASE OF AN EMERGENCY -

Format: (000) 000-0000.

NAME OF INDIVIDUAL PICKING THE CHILD UP -

PLEASE CALL LESLIE AT 828-234-6236 IF THIS CHANGES.

THANKS