Splash Zone Kids Update
Please fill out this form and click submit.
Child Name #1
*
Birthdate
*
Grade
Child Name #2
*
Birthdate
Grade
Child Name # 3
Birthdate
Grade
Child Name # 4
Birthdate
Grade
Parent/ Guardian #1
*
Parent/ Guardian #2
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone
*
Authorized Pick Up #1
Authorized Pick Up #1 - Name
*
Authorized Pick Up #1 - Phone
*
Authorized Pick Up #1 - Email
*
Authorized Pick Up #2
Authorized Pick Up #2 - Name
Authorized Pick Up #2 - Phone
Authorized Pick Up #2 - Email
Information
Allergies/ Special Considerations
*
Electronic Signature
*
By entering my name in the text above I am providing my digital signature on this form. I give my permission for my child to take a full and active part in the Splash Zone activities. I understand that my Child’s (audio/visual/testimonial) may be used for promotional purposes. By clicking submit you agree that your child can be photographed.
Upload a recent photo of your child
Upload (8MB)
Submit
Description
Please fill out this form and click submit.
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