Health Form

Please take a few minutes and fill out the health information below for your child registered. If you have any questions, please let us know.

Child's Name

First Name

Last Name

Grade when entering the show:

Select Show

Birth Date

YYYY

Parent / Guardian's Name

First Name

Last Name

Street Address

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Emergency Phone

(###)

###

####

Medical Info

Doctor's Name / Phone Number

Dentist's Name / Phone Number

Orthodontist's Name / Phone Number

Allergies

(Please see the Waiver and Release regarding allergy policy)