Children’s Registration Form For any questions, please contact Celeste White 707-479-3332 Parent/Guardian #1 Name * First Name Last Name Email * Mobile Number * Relationship to Child * Does this Parent/Guardian live at the primary residence of the child(ren)? * List full names (and their relationship to the child) of other adults authorized to pick up your child: Parent/Guardian #2 Name First Name Last Name #2 Mobile Number #2 Email Does this Parent/Guardian live at the primary residence of the child(ren)? Primary Residence of Child(ren) Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact (other than Parent/Guardian) Name * First Name Last Name Phone * (###) ### #### Child's Information Please complete separately for each child. Child #1 Name * First Name Last Name Date of Birth * MM DD YYYY Gender * School Grade * Allergies or Special Needs? * If yes, please list all below. Child #2 Name First Name Last Name Date of Birth MM DD YYYY Gender School Grade Allergies or Special Needs? If yes, please list all below. Child #3 Name First Name Last Name Date of Birth MM DD YYYY Gender School Grade Allergies or Special Needs? If yes, please list all below. Child #4 Name First Name Last Name Date of Birth MM DD YYYY Gender School Grade Allergies or Special Needs? If yes, please list all below Thank you!