We want to have a buddy ready for your child. Let us know you are coming and a little bit of information about your child by filling out the form below. We look forward to seeing you!

Child's Name

First Name

Last Name

Date of Birth

Gender

Male

Female

Father's Name // Guardian's Name

First Name

Last Name

Father's Phone // Guardian's Phone

(###)

###

####

Father's Email // Guardian's Email

Mother's Name // Guardian's Name

First Name

Last Name

Mother's Phone // Guardian's Phone

(###)

###

####

Mother's Email // Guardian's Email

My child has the following diagnosis, medical condition or learning difference

My child has the following allergies and/or food sensitivities

My child's allergies can be life threatening

Yes

No

My child needs the use of an EpiPen

Yes

No

My child needs assistance with

A trigger-point for a potential meltdown is

My child is most relaxed in settings

Alone

With few children

With many children

Additional information you would like us to know