Wee Wednesday's
2007-2008 Registration Form

Child's Name:   ___________________________________________________

Birth Date:        ___________________________________________________

Parent's Name:  ___________________________________________________

Street Address:  ___________________________________________________

                          ___________________________________________________

Phone Number        Home: _________________        Cell: _________________

Emergency Numbers: ______________________________________________

Allergies:          ____________________________________________________

Insurance Information in case of emergency: ____________________________

Other information, that might help us with your child: _____________________

_________________________________________________________________

Other family or friends who may also have permission to pick up your child:

_________________________________________________________________

_______________________________________
                Legal Guardian Signature

Do we have permission to photograph your child? ________________________