Permission for Treatment by Doctor/Hospital:
Is Member currently on any Medications that EMT's may need to be aware of in the event of an emergency?
Annual Household Income
Is there a Member of the Household 65 years old or older?
Is there a Member of the Household Handicapped?
Current Head of Household:
Current Single Parent:
Relationship to Member:
Back Pack Color - please select your child's first three choices of colors. We will make every effort to ensure your child gets their choice of color; however, there are limited quantities of each.
The registration fee is $15 per child.