Kid’s Club Emergency Contact Form

2021 Fall Emergency Contact and Health Form

Child's Name(Required)

First Last

Parent/Guardian Email(Required)

Enter Email Confirm Email

Kid's Club(Required)

Name of person authorized to pick up your child:(Required)

First Last

Phone(Required)

List any additional authorized pick ups and their phone numbers:

Does your child have any allergies?(Required)

Can your child self-dismiss? (4th & 5th grade ONLY)(Required)