Child's Information:
First and Last name:
Birthday/Age of Child:
Mailing Address:
Parent's Email Address:
Parent/Guardian's Names and Contact Numbers:       Please list all adults allowed to pick up child: Please list any allergies or other important medical information:     Child's Pediatrician: Pediatrician's Phone #: Insurance Company/Policy #:
Class Info:
Desired class name:   First choice of time/day:   Second choice of time/day:
Best way to contact you:	Email address Mailing address Phone