REGISTRATION FORM

CHILD INFORMATION
FIRST NAME: LAST NAME:
DATE OF BIRTH:   mm/dd/yy GENDER: BOY    GIRL
ADDRESS: CITY:   ZIP:  
HOME PHONE:   xxx-xxx-xxxx EMAIL:
PARENT/GUARDIAN INFORMATION
FATHER'S NAME: MOTHER'S NAME:
WORK PHONE:    xxx-xxx-xxxx WORK PHONE:   xxx-xxx-xxxx
MOBILE PHONE:   xxx-xxx-xxxx MOBILE PHONE:   xxx-xxx-xxxx
1. HOW OFTEN AND WHICH DAY(S) WOULD YOU PREFER FOR THE WEEKEND ACTIVITIES TO BE SCHEDULED?
EVERY 2 WEEKS MONTHLY BI-MONTHLY SATURDAYS SUNDAYS

2. IS THERE A STAY-AT-HOME PARENT IN YOUR FAMILY?   YES        NO        IF NO, GO TO QUESTION #3.
IF YES, WHICH ONE?       MOTHER      FATHER      GRANDPARENT

AS A STAY-AT-HOME PARENT, WOULD YOU LIKE TO HAVE ACTIVITIES FOR YOUR KID(s) DURING THE WEEK?

YES       NO

3. WHAT TYPE OF KIDS CLUB ACTIVITIES WOULD YOU PARTICIPATE?  SELECT ALL THAT APPLY:
PARK DAYS PICNICS FIELD TRIPS POOL DAYS
AMUSEMENT PARK OUTINGS SPORT ACTIVITIES @HOME PLAYGROUPS MUSIC CLASSES
DANCE CLASSES MOVIE EVENTS OTHER:
4. WE NEED YOUR HELP. WOULD YOU LIKE TO VOLUNTEER TO WORK FOR THIS CLUB?   YES      NO
5. PLEASE SHARE ANY COMMENTS AND RECOMMENDATIONS YOU MAY HAVE TO HELP OCTAA KIDS CLUB IMPROVE ITS SERVICE:
        
 
 
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