Children's Connect Card

Please fill out this form and click submit.

Child #1 Name

*

Gender

*

Please select one option.

Male Female

Date of Birth

*

Grade Level

*

Allergies or Medical Conditions

*

Child #2 Name

Gender

Please select one option.

Male Female

Date of Birth

Grade Level

Allergies or Medical Conditions

Child #3 Name

Gender

Please select one option.

Male Female

Date of Birth

Grade Level

Allergies or Medical Conditions

Child #4 Name

Gender

Please select one option.

Male Female

Date of Birth

Grade Level

Allergies or Medical Conditions

Parent/Guardian #1 Name

*

Today's Date

*

Relation to Child

*

Please select one option.

Mother Father Grandparent Other

If "Other," please explain here.

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Parent/Guardian #2 Name

Relation to Child

Please select one option.

Mother Father Grandparent Other

If "Other," please explain here.

Phone

Email

Address

Is your family a first time guest or returning guest?

*

Please select one option.

First Time Guest Returning Guest

Description

Please fill out this form and click submit.

Please Fix the Following

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