Registration - Kids Life Group 2019 - 2020

Child's Name: *
Child's Name:
Child's Date of Birth: *
Child's Date of Birth:
Child's Sex: *
Parent/Guardian's Name: *
Parent/Guardian's Name:
Parent/Guardian's Phone: *
Parent/Guardian's Phone:
Parent/Guardian's Address *
Parent/Guardian's Address
Please list all allergies of child. If none, write "none".
DAY *