GENKIDS HOLIDAY PROGRAM

GENKIDS HOLIDAY PROGRAM REGISTRATION

JULY 3 - JULY 6, 2023

PREP - GRADE 6 CHILDREN

* Indicates required field

Parent / Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

PHONE NUMBER *

CHILD 1 NAME *

CHILD 1 D.O.B *

CHILD 1 SCHOOL YEAR *

CHILD 2 NAME *

CHILD 2 D.O.B *

CHILD 2 SCHOOL YEAR *

CHILD 3 NAME *

CHILD 3 D.O.B *

CHILD 3 SCHOOL YEAR *

CHILD 4 NAME *

CHILD 4 D.O.B *

CHILD 4 SCHOOL YEAR *

DAYS ATTENDING *

MONDAY 3RD JULY TUESDAY 4TH JULY WEDNESDAY 5TH JULY THURSDAY 6TH JULY

ALLERGIES *

EMERGENCY CONTACT NAME (DIFFERENT TO PARENT / GUARDIAN ALREADY PROVIDED) *

EMERGENCY CONTACT PHONE NUMBER (DIFFERENT TO PHONE NUMBER ALREADY PROVIDED) *

Submit

Please download, print, fill in and return the Family Medical Form to us when you drop your child/ren at GENKIDS Holiday Program: