1. PARTICIPANT INFORMATION Participant Name (required) Date of Birth (required) Gender (required) Mobility or Medical Concerns (required) Dietary Allergies or Intolerances (required) Does your athlete have any special interests? (dinosaurs, princesses, animals, trains, sports, etc.) 2. EMERGENCY CONTACT INFORMATION Parent or Guardian Name (required) Contact Number (required) Secondary Contact Number Your Email (required) Note: The email address given above will be used to inform you of important program information only and will not be used for marketing purposes nor will it be shared with a third party. Mailing Address Are there any individuals who may be picking up your children from the program? YesNo If yes, please provide first and last names: 3. TIME AVAILABILITY Select an available time that works for you and your child: 1:30-2:30 PM2:30-3:30 PM3:30-4:30 PM 4. PARENTAL CONSENT PLEASE READ the Parental Consent form located here before submitting your registration form. I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT.