KC Registration Mom2Mom Fall
CHILD REGISTRATION
Please enter
child
information on this form
Please note: Childcare for this event is available for infants through age 5 at $20 PER FAMILY.
*
Child
First Name
*
Child
Last Name
*
Child
Birth Date
* Are there any allergies or special needs of which we need to be aware?
* Age/Grade (Tuesday AM KidCare - Fall)
Select one
Infant (less than 12 months) [3 left]
Toddlers (Age 12 to 24 months) [15 left]
2-3 (24-36 months) [11 left]
3-5 years old [16 left]
WAITLIST - If your age group is full, select this option to be added to the waitlist
* I give my consent for my child to play outside on the Pathway playground.
Select one
Yes
No
* Electronic Parent Signature (Typing your name into the below box indicates your full assumption of risk, authorization, and release of liability in accordance with the above participation agreement)
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