Registration for Wednesday L.I.F.E. (Adult & children)

September 13 - October 18, 2017

Adult Registration *
Adult Registration
Telephone *
Telephone
Do you and/or your children have any medical conditions including food allergies we should know about?
Do you or your child have an Epi-pen?
Will you require child care during L.I.F.E.? *
If your child(ren) require child care, please share their name(s), age and any additional information including allergies, helpful to ensure proper care.
If you have children attending L.I.F.E. classes, please share their names grades and ages.
Phone for Emergency Contact
Phone for Emergency Contact
In the unlikely event of an emergency, please provide the number of an emergency contact.
We occasionally post pictures of children to our website and to our Facebook page. Children are never identified by name. If you would like us to refrain from using your child's picture on our website/Facebook, please check below to opt out.