Kids ROCK/Club 56 Registration

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

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