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: _____________________