Child's Name                                Grade entering this fall    Age
                   
                
   Gender:
  
M F

T-Shirt  (Y or N) and size (in adult sizes - S, M, L) cost $7

Address:
  City, State, Zip:

Daytime Phone Number:


Email:


Emergency Contact Name & Phone#:


Who is allowed to pick up your child (include yourself):
Name and Relationship to child:

1.

2.

3.