theZONE Registration
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name(s):*
Address
Phone Number (xxx-xxx-xxxx):*
Cell Phone:
Do you send/receive text messages?
 Yes
 No
Email:
Emergency Contact Name (In event Parent/Guardian cannot be reached):*
Emergency Contact Phone:*
Who may pick up your child(ren) other than the Parent/Guardian listed?*
PARTICIPANT INFORMATION (Note: If you have more than four participants to register, you must complete additional forms)
CHILD 1 - Name (Last, First, MI):*
CHILD 1 - Birthdate (xx/xx/xxxx):
CHILD 1 - Current Grade or Grade Last Completed (if school is not in session):*
CHILD 1 - School Attended:
CHILD 1 - Does your child have any allergies or medical conditions we need to be aware of?
 Yes
 No
CHILD 1 - If yes, please explain:
CHILD 2 - Name (Last, First, MI):
CHILD 2 - Birthdate (xx/xx/xxxx):
CHILD 2 - Current Grade or Grade Last Completed (if school is not in session):
CHILD 2 - School Attended:
CHILD 2 - Does your child have any allergies or medical conditions we need to be aware of?
 Yes
 No
 N/A
CHILD 2 - If yes, please explain:
CHILD 3 - Name (Last, First, MI):
CHILD 3 - Birthdate (xx/xx/xxxx):
CHILD 3 - Current Grade or Grade Last Completed (if school is not in session):
CHILD 3 - School Attended:
CHILD 3 - Does your child have any allergies or medical conditions we need to be aware of?
 Yes
 No
 N/A
CHILD 3 - If yes, please explain:
CHILD 4 - Name (Last, First, MI):
CHILD 4 - Birthdate (xx/xx/xxxx):
CHILD 4 - Current Grade or Grade Last Completed (if school is not in sesssion):
CHILD 4 - School Attended:
CHILD 4 - Does your child have any allergies or medical conditions we need to be aware of?
 Yes
 No
 N/A
CHILD 4 - If yes, please explain:
Any other information you would like to make us aware of?
I, as the parent/guardian of the above registered child(ren) have read and agreed to the COVID Safe Requirements for theZONE found at www.earlingtonfbc.com/COVIDtheZONE .*
Please enter an email address if you would like to have a receipt of your online registration:


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