COOL KIDS REGISTRATION
Please fill out this form and click submit.
FAMILY INFORMATION
Please enter information about the parent or guardian.
Name
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone
*
Birthdate
Email
*
This address will receive a confirmation email
FIRST CHILD INFORMATION
First Name
*
Last name
*
Age
*
Grade
*
Birthdate
*
Allergies
*
Please select one option.
YES
NO
List allegies
Special needs child?
*
Please select all that apply.
YES
NO
SECOND CHILD INFORMATION
If you are only registering one child, please skip and submit your form.
First Name
Last Name
Age
Grade
Birthdate
Allergies?
Please select one option.
Yes
No
List allergies
Special needs child?
Please select one option.
Yes
No
THIRD CHILD INFORMATION
First Name
Last Name
Age
Grade
Birthdate
Allergies?
List allergies
Special needs child?
Please select one option.
Yes
No
FOURTH CHILD INFORMATION
First Name
Last Name
Age
Grade
Birthdate
Allergies
Please select one option.
Yes
No
List allergies
Special needs Child?
Please select one option.
Yes
No
Submit
Description
Please fill out this form and click submit.
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