YS Program

 

*

1. Family's last name

Family's last name

*

2. Number of family members attending

Number of family members attending

*

3. First and last name of caregiver or parent.

First and last name of caregiver or parent.

*

4. Telephone

Telephone

*

5. Emergency Telephone

Emergency Telephone

6. Does your child have any health-related problems or allergies to food, glue, crayons, etc.?

Does your child have any health-related problems or allergies to food, glue, crayons, etc.?   Yes

No

7. If you answered yes, please comment:

If you answered yes, please comment:

8. E-Mail Address (only if you prefer we contact you this way)

E-Mail Address (only if you prefer we contact you this way)

9. Thank you for registering!

I understand that parents/caregivers must remain in the library with children aged ten and under.

Thank you for registering! I understand that parents/caregivers must remain in the library with children aged ten and under.   I agree