echo enrichment center~new registration
parents/guardians____________________________
address____________________________________
home phone_____________email________________
work phone_____________cell phone_____________
work phone_____________cell phone_____________
emergency contact person_______________________
home phone_______________cell phone___________
child__________________________________M/F
date of birth_______________________age_______
allergies___________________________________
important info about your child___________________
__________________________________________
child__________________________________M/F
date of birth________________________age______
allergies____________________________________
important info about your child____________________
_____________________________________________________
child__________________________________M/F
date of birth__________________________age_____
allergies____________________________________
important info about your child____________________
__________________________________________
PHOTO RELEASE----I do/do not grant permission for the above participants.
signature_____________________date___________
Mailing address: 9R Bedford Street, Burlington, MA 01803
