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What would I need for this form? 

Childs: Full Name, DOB, any medical conditions & Picture of your child.
Parents: Full Name, Your relationship to the child, Phone number & Address.
Emergency contacts: Full Name, Your relationship to the child, Phone number & Address.
Any other issues regarding the child that we need to know.

CHILD 1 DETAILS

* Indicates required field

childs 1 Name *

First

Last

Childs 1 DOB *

CHILD 1 Allergies/ medical conditions *

CHILD 1 Other medical issues *

Upload childs 1 photo *

Max file size: 20MB

CHILD 2 DETAILS

CHILD 2 Name *

First

Last

Childs 2 DOB *

CHILD 1 Allergies/ medical conditions *

CHILD 2 Other medical issues *

Upload childs 2 photo *

Max file size: 20MB

PARENT/ GUARDIAN 1 DETAILS

parents 1 Name *

First

Last

Relationship to child *

Other relationship *

parent 1 phone no. *

Parent 1 Email *

Parent 1 Address *

Line 1

Line 2

City

State

Zip Code

Country

PARENT/ GUARDIAN 2 DETAILS

Parent 2 Name *

First

Last

Relationship to child *

other relationship *

parent 2 phone no. *

parent 2 Email *

parent 2 Address *

Line 1

Line 2

City

State

Zip Code

Country

EMERGENCY CONTACT DETAILS

Emergency contact Name *

First

Last

Relationship to child *

Other relationship *

emergency Phone no. *

Email *

Emergency contact Address *

Line 1

Line 2

City

State

Zip Code

Country

Please state if there is any thing else we need know: *

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