Number (Staff Use Only)_______________

                        Story Hour                               After School Adventurers
                        Age______                              Grade_______________

Child’s Name________________________________________________________

Parents’ Names_______________________________________________________

Address_____________________________________________________________

Phone__________________               Email Address__________________________

Emergency Contact and Phone___________________________________________

Known Allergies (Foods or Medication, etc.)________________________________

*All permission slips and registration for programs must be completed and turned in one week before the program to guarantee your child’s space. 

 

 

 

Program Registration Form