Parent or Guardian's Name

First Name

Last Name

Parent or Guardian's Phone

(###)

###

####

Parent or Guardian's Email

Please list the names and ages of all children attending

Please list all allergies or other medical conditions of which childcare workers should be aware:

I understand that I am being asked supply my child with with a sack supper for this event (drinks provided.)

Yes, I will provide a sack supper for my child.

Please note that we will be serving popcorn and Christmas cookies at this event, but will adhere to any allergy restrictions indicated in a child's registration.