New Year’s Eve Sleepover Registration Form
Child’s Name: _____________________________________________ Birthdate: ______________________________
Allergies: _______________________________________________________________________________________
Parent Name: _________________________________________________ Phone: ____________________________
Parent Name: _________________________________________________ Phone: ____________________________
Address: ________________________________________________________________________________________
Emergency Contact: __________________________________________ Relationship: _________________________
Phone: ________________________________________
I authorize staff at the Kangaroo Clubhouse that is trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the program to transport my child to the nearest medical care facility and/or to _________________________________, and to secure necessary medical treatment for my child. Kangaroo Clubhouse will not be responsible for medical costs in the event of an emergency.
Kangaroo Clubhouse may use photos of my child for advertising purposes. __________ (initial)
Parent Signature: ____________________________________________________________ Date: _____________________
New Year’s Eve Sleepover Registration Form
Child’s Name: ____________________________________________________ Birthdate: ____________________________
Allergies: ____________________________________________________________________________________________
Parent Name: __________________________________________________ Phone: ________________________________
Parent Name: __________________________________________________ Phone: ________________________________
Address: ____________________________________________________________________________________________
Emergency Contact: _____________________________________________ Relationship: __________________________
Phone: ____________________________________
I authorize staff at the Kangaroo Clubhouse that is trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the program to transport my child to the nearest medical care facility and/or to _________________________________, and to secure necessary medical treatment for my child. Kangaroo Clubhouse will not be responsible for medical costs in the event of an emergency.
Kangaroo Clubhouse may use photos of my child for advertising purposes. __________ (initial)
Parent Signature: ____________________________________________________________ Date: _____________________