LPKids Pre-Registration
Please fill out this form and click submit.
Guardian #1 (use this section for preferred contact):
Name
*
Email
*
This address will receive a confirmation email
Relationship to Child
*
Phone
*
If needed, may we text this number during service about your child?
*
Please select one option.
Yes
No
Child Name
*
Birthdate
*
Child 2
Birthdate
Child 3
Birthdate
Child 4
Birthdate
Child Pick-Up
Please list any adults (18+) not listed above that have your permission to pick your child up from LPKids:
Is there any other information you would like to share to help us care for your family? (Allergies, Anxieties, or Issues, etc.)
Submit
Description
Please fill out this form and click submit.
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