Kidz Registration Form
Please fill out a separate form for each child.
Name
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Date of Birth
*
Grade
*
Please select one option.
Under Pre-K
Pre-K
1st
2nd
3rd
4th
5th
Select Option
Under Pre-K
Pre-K
1st
2nd
3rd
4th
5th
School
Allergies
*
Other
Primary Adult (Name)
*
Primary Adult's Address (only if different than child's)
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Primary Adult's Phone
*
Primary Adult's Email
*
This address will receive a confirmation email
Primary Adult's Relationship to Child
*
Adult #2 (Name)
Adult #2 (Phone)
Adult #2 (Email)
This address will receive a confirmation email
Adult #2 Relationship to Child
*
Submit
Description
Please fill out a separate form for each child.
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