Let’s finish registration!

Please complete this Emergency Contact Form before the first day of class.

Participant's Name

First Name

Last Name

Age

Gender Pronoun

Medication/Allergies/Food Restrictions

Additional notes on medication/allergies/food restrictions

Parent / Guardian #1 Email

Parent / Guardian #1 Phone

(###)

###

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Parent / Guardian #2

Parent / Guardian #2 Email

Parent / Guardian #2 Phone

(###)

###

####

Emergency Contact Person (other than parents / guardians)

Emergency Contact Relation to Participant

Emergency Contact Person's Phone

(###)

###

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