Movement Kids Registration
Please fill out this form and click submit.
One form for each child
Name
*
Birthdate
*
Age/Grade
*
Please select one option.
4 Years Old
5 Years Old
1st
2nd
3rd
4th
5th
Select Option
4 Years Old
5 Years Old
1st
2nd
3rd
4th
5th
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone
*
Email
*
This address will receive a confirmation email
Authorized Pick-up
*
Emergency Contact (Other than Parent/Guardian)
Name
*
Phone
*
Special Needs/Allergies
List any allergies or special needs we should be aware of:
Submit
Description
Please fill out this form and click submit.
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