Formulario

Parent/Guardian Information
Parent/Guardian Name *
Primary contact for Student
E-mail *
Mobile Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
I Agree to receive text messages on the mobile number listed above for emergency notifications and important reminders about the program. *

Yes No
Parent/Guardian Name *
Secondary contact for Student
E-mail *
Mobile Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
I Agree to receive text messages on the mobile number listed above for emergency notifications and important reminders about the program. *

Yes No
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Should be Empty:

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Christmas Kids Club