Child’s Information

Child Name^*

Child Last Name^*

Child Grade^*

Child Birthday^*

Parent 1 Information

Parent 1 Name^*

Parent 1 Last Name^*

Email^*

Parent 1 Phone^*

Address

Parent 2 Information

Parent 2 Name

Parent 2 Last Name

Parent 2 Phone

Address

Weekend / After School Programs

Location^*

Weekend / After School^*

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