General Information
Parent/Guardian's Name *
Parent/Guardian's Name
Child's Name *
Child's Name
Child's Birth Date *
Child's Birth Date
Parent/Guardian's Home Address *
Parent/Guardian's Home Address
Parent/Guardian's Cell Phone *
Parent/Guardian's Cell Phone
Parent/Guardian's Home Phone *
Parent/Guardian's Home Phone
DROP OFF/ Pick Up Information
In addition to myself, the following individuals are authorized to pick up my child:
Drop Off/Pick Up Person 1
Drop Off/Pick Up Person 1
Drop Off/ Pick Up Person 2
Drop Off/ Pick Up Person 2
Drop Off/Pick UP Person 3
Drop Off/Pick UP Person 3
Helpful Information
Please complete this form so we can be are of your child's needs
Please list if there is anything that is especially comforting to your child.
Does the child have any medical need that River City Kids needs to know? *
Does your child have any allergies? *
Does the child have any condition that would prevent him/her from participating in any River City Kids activities? *
Does the child take any prescription medications? *
Please indicate any additional information that River City Kids should know about your child:
Authorization
I am authorizing River City Kids to take care of my kids and confirm that all information I have shared is accurate and up to date. To confirm, hit the "SUBMIT" button.