Emergency Contact FormPlease fill out as accurately as possible. Information is for the safety of your child while within our care. Child's Name * First Name Last Name Birth Date * MM DD YYYY Grade * Class/Workshop Name * From Registration Parent/Guardian Name * First Name Last Name Name of Other Person(s) Approved to Pick up Child From Class If Any First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number * Email * Medical Concerns (Allergies, etc.) Thank you!
