Event Registration Form

Child's Name

First

Last

Date of Birth

Date

Time

Child's T-Shirt Size

Gender

Female
Male

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian

Mother's Name

First

Last

following of Address

Father's Name

First

Last

Phone

Emergency Contact

Name

First

Last

Phone

I agree to the following system

If my child exhibits behavior problems, I will work with staff to address and resolve these issues. I also understand that if the behavior issues remain unresolved, my child cannot continue attending MPAL programs until the problems are corrected

I hereby consent to and authorize the use by MPAL of any photographs, video, voice recording, and other media taken of my child.