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806-794-4203
5812 73rd St.
Lubbock, Texas  79424
Event Registration
Child's Full Name:
(example: John Smith)*
Birthdate (mm/dd/yyyy)*
Second Child's Last Name:
Second Child's Birthdate (mm/dd/yyyy)
Third Child's Full Name:
Third Child's Birthdate (mm/dd/yyyy)
Parents'/Guardians' Names*
Street Address*
City, State Zip Code*
Home Phone*
E-mail Address*
Emergency Contact Person & Relationship to Student*
Emergency Person's Contact Phone Number*
If your child has an allergy or medical condition, please indicate and explain below. *
 Yes
 No
If answered yes, please explain.
People who may pick up the child*
How did you hear about this event?*
May we include your child in pictures on our website and other outreach materials? (Children's names will not be used.)*


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