Winter Cub Drop-Off Program Survey

1.My Name is:(Required.)

2.My Child's Name is:(Required.)

3.My Child's Age is:

4.I will:(Required.)

drop off my child for 2 days per week

drop off my child for 3 days per week

5.My PayPal email address is (this will be used for billing purposes):

6.My child:

has food allergies.

does not have any food allergies.

Allergies are (please specify):

7.Other social settings:

My child is NOT taking part in other social experiences.

My child is taking part in other social experiences.

Here is what we do that involves a social setting: