TSBC Summer Activity Registration Form Question Title * 1. WHAT IS YOUR ADDRESS STREET Question Title * 2. WHAT IS YOUR ZIP CODE Question Title * 3. DO WE HAVE PERMISSION TO PHOTOGRAPH AND SHARE ON SOCIAL MEDIA? Yes No Question Title * 4. NAME OF CHILD #1 Question Title * 5. DATE OF BIRTH OF CHILD #1 Question Title * 6. What grade did CHILD #1 last complete? Question Title * 7. WHAT IS THE NAME OF CHILD #2 Question Title * 8. DATE OF BIRTH OF CHILD #2 Question Title * 9. LAST GRADE CHILD #2 COMPLETED Question Title * 10. NAME OF CHILD #3 Question Title * 11. DATE OF BIRTH OF CHILD #3 Question Title * 12. LAST GRADE CHILD #3 COMPLETED? Question Title * 13. NAME OF CHILD #4 Question Title * 14. DATE OF BIRTH OF CHILD #4 Question Title * 15. LAST GRADE CHILD #4 COMPLETED? Question Title * 16. Parent or Guardian's names? Question Title * 17. Phone number where guardian(s) can be contacted? Question Title * 18. If guardian cannot be reached, who should we contact & where? Please list relationship to child(ren) Question Title * 19. Who is authorized to pick child(ren) up? (List all.) Question Title * 20. What is your email address? Question Title * 21. Please list any allergies (including food allergies), physical condition, defects or medical conditions that would limit Child #1 from participating in any activity. Question Title * 22. Please list any allergies (including food allergies), physical condition, defects or medical conditions that would limit Child #2 from participating in any activity. Question Title * 23. Please list any allergies (including food allergies), physical condition, defects or medical conditions that would limit Child #3 from participating in any activity. Question Title * 24. Please list any allergies (including food allergies), physical condition, defects or medical conditions that would limit Child #4 from participating in any activity. Question Title * 25. How did you learn aboutTSBC summer activities? Question Title * 26. Limited bus pick up may be available. If you need bus pick up, please indicate this. Yes No Done