subject_line
Parent/Guardian & Contact Information
Parent Guardian Name
*
Street Address
*
City
*
Zip Code
*
Home Phone Number
*
Cell Phone Number
*
Email Address
*
Photographs of Child?
*
Yes
No
Emergency Contact Other than Parent
*
Relationship
*
Phone Number
*
Individuals Authorized to Pick Up Child
*
Home Church
*
Clubber #1 Information
Clubber's Name
*
DOB
*
+
Age
*
School Grade
*
Club Membership
*
Puggles (2-3 yr olds)
Cubbies (4 yr old-K)
Sparks (1-2 grade)
T&T (3-6 grade)
Hobbies/Activities
*
Medical Conditions (Including Allergies)
*
Clubber #2 Information
Clubber's Name
DOB
+
Age
School Grade
Club Membership
Puggles (2-3 yr olds)
Cubbies (4 yr old-K)
Sparks (1-2 grade)
T&T (3-6 grade)
Hobbies/Activities
Medical Conditions (Including Allergies)
Clubber #3 Information
Clubber's Name
DOB
+
Age
School Grade
Club Membership
Puggles (2-3 yr olds)
Cubbies (4 yr old-K)
Sparks (1-2 grade)
T&T (3-6 grade)
Hobbies/Activities
Medical Conditions (Including Allergies)
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