Registration Form Email * Phone * (###) ### #### Date * MM DD YYYY Date Of Birth * Gender School of student: * Resident Town in Delaware County/ Zip code: * Dietary Restrictions/allergies: * Name of parents: * Parent/Guardian Phone number and email * Emergency contact cell number (other than parent/guardian) * Pick up & drop off: Please choose which is applicable; will your child be: * Walking to the summer program Dropped off and picked up by a parent/guardian Using other means of transportation: Any medical issues or conditions, please state: *
