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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 grade

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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? Please note that this program involves foods including wheat, eggs and dairy. While the food does not contain nuts, the preparation environment was not nut-free.

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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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