Please complete the following form and your family information will be added to our files. Please keep in mind that additional forms may be required for summer camp participation or school transportation. You will also need to provide immunization information for your child. This can be brought with you on your first visit or faxed to 918-274-0125. Thank you and we look forward to seeing you!
Mother's Name:
Mother's Address:
City:
State:
Zip:
Father's Name:
Father's Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
Employer:
Email:
Home Phone:
Cell Phone:
Work Phone:
Employer:
Email:
Parent Information:
Children's Information:
Child 1's Name:
Date of Birth:
School:
Child 2's Name:
Date of Birth:
School:
Child 3's Name:
Date of Birth:
School:
Child 4's Name:
Date of Birth:
School:
Emergency Contact Information:
Contact1's Name:
Phone:
Contact 2's Name:
Phone:
Person's authorized to pick up your child:
NOTE**we will not release your child to anyone not on your pick up list for any reason!
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