Child 1: Name *

First Name

Last Name

Child 1: Birthday *

MM

DD

YYYY

Gender *

Male

Female

Child 2: Name

First Name

Last Name

Child 2: Birthday

MM

DD

YYYY

Gender

Male

Female

Child 3: Name

First Name

Last Name

Child 3: Birthday

MM

DD

YYYY

Gender

Male

Female

Child 4: Name

First Name

Last Name

Child 4: Birthday

MM

DD

YYYY

Gender

Male

Female

Parent/Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact 1 *

First Name

Last Name

Phone 1 *

(###)

###

####

Emergency Contact 2 *

First Name

Last Name

Phone 2 *

(###)

###

####

May we have permission to photograph your child(ren)? *

YES

NO

May we have permission to use your child(ren)’s photograph for the purpose of promotion? *

YES

NO