Peak Kids Registration

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Fields marked with an * are required

Child 1 Name

Child 1 Gender

Child 1 Birthdate

Child 1 Age

Child 1 Allergies

Child 2 Name

Child 2 Gender

Child 2 Birthdate

Child 2 Age

Child 2 Allergies

Child 3 Name

Child 3 Gender

Child 3 Birthdate

Child 3 Age

Child 3 allergies

Parent/Guardian Name

Parent/Guardian Address

Parent/Guardian Phone for Texting

Parent/Guardian Email

Are you a member of McConnell?

Who is Checking in the Child(ren) Today?

Relationship to Child

Emergency Contact Name and Phone #

Who else can pick your child up? Must be over 18

Who?

Your Comments, Questions or any special information about your child.