Parent Name *
Parent Name
Parent Address *
Parent Address
Parent Phone *
Parent Phone
Please enter a mobile phone where you can be reached.
Name of adult authorized to pick up child(ren)
Name of adult authorized to pick up child(ren)
Please list the name of an adult, not listed above, that is authorized to pick up the children you are registering. If no one else, please enter 'none'.
Child 1 Information
Child 1 Name *
Child 1 Name
I'm going to be in...
Birth Date *
Birth Date
Please enter Child 1's Birth Date.
Child 2 Information
I;m going to be in...
Birth Date
Birth Date
Please enter Child 2 Birth Date
Please list allergies for child 2. If 'none', please enter 'none'.
Child 3 Information
I'm going to be in...
Birth Date
Birth Date
Please enter child 3 birth date.
Please list allergies here for Child 3. If 'none' please enter 'none'.
Will this child be attending dinner at 5:30?
Days you will be coming to 5:30 dinner:
Select the creative focus for your child 1
Select the creative focus for your child 2
Select the creative focus for your child 3
I understand that my children will be performing/presenting on Sunday Morning June 24 *

Thank you for signing up for Summer Jam 2018!  June 18th-22nd from 6pm to 8pm.  If you have any questions, please contact Meredith.