Your Name (required)
Your Email (required)
Child's Name
Grade
Address
City
State
Zip
D.O.B.
Email
Allergies/Medical Conditions: (food & environment)
Special Needs:
T-Shirt Size Child X-SmallChild SmallChild MediumChild LargeAdult-SmallAdult-MediumAdult-LargeAdult-XLAdult-XXL
Comments:
Parent/Guardian Contact Information
Parent/Guardian Name(s)
Address (if different than child)
Home Phone
Work Phone
Cell Phone
Parent/Guardian Signature
Date
Parents of Club 56 Kids please see John Shirron to sign a special Permission Slip. How Can I Help?
DirectorGather SuppliesMusicGamesCraftsClub 56 Circle Leader (Riverguide)Set Up/Clean Up
