June 21-25, 2021

Child's Name (required)

Parent's Name (required)

Your Address (required)

City (required)

Phone Number (required)

Child's Age (required)

Child's Grade just completed (required)

Shirt Size (required)

Medical Info (if any)

Emergency Contact(required)

Van Pickup and Drop-off (required)

Who will pick up your child each day, if riding van write "van" (required)

Any additional information you would like to provide

May we have permission to photograph your child (required)

May we have permission to use your child's photograph for promotion (required)