Wacky Wednesday Registration What dates do you plan on attending? June 7 June 21 June 28 July 12 July 26 Aug 2 Child's Name (First and Last) Child’s Birthdate(MM/DD/YYYY) How many children in your family will attend? If new to Kidz Zone please complete the rest of this form, otherwise just click Submit. Child’s Age Child’s Grade Just Completed (K-5th) If not in school yet, leave blank Parent/Guardian Name (First, Last) Parent Email Parent Cell # Parent Home Phone Street Address City State Zip Medical Concerns (Allergies, etc.) Other Information Additional Adult Authorized to Pick Up Child (other than parent) Contact Phone # Additional Adult Authorized to Pick Up Child (other than parent) Contact Phone # Do you give permission for us to use pictures of your child for social media? Yes No Captcha If you are human, leave this field blank.
