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* 1. Child’s name or nickname (please indicate the name your child would like to have the librarian use when taking attendance)

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* 2. Child's age

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* 3. First and last name of Parent or Caregiver accompanying the child

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* 4. Telephone

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* 5. Emergency Telephone

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* 6. Does your child have any health-related problems or allergies (food, crayon, glue, etc.) that would limit class participation?

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* 7. If you answered yes, please comment:

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

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