Family Event Signups - Lakes Region Community Services

children playing

Family Event Signups

Name of Activity*
Parent Name*
First Last
Parent Date of Birth*
MM slash DD slash YYYY

Contact Phone*
Email*

Address*
Street Address Address Line 2 City State ZIP Code

Child #1 Name*
First Last
Child #1 Date of Birth*
MM slash DD slash YYYY

Child #2 Name
First Last
Child #2 Date of Birth
MM slash DD slash YYYY

Child #3 Name
First Last
Child #3 Date of Birth
MM slash DD slash YYYY

Child #4 Name
First Last
Child #4 Date of Birth
MM slash DD slash YYYY

Child #5 Name
First Last
Child #5 Date of Birth
MM slash DD slash YYYY