EmailMe Form - Winter Warm Up Registration

Parent/Guardian Name *
First Last
Phone *
### - ### - ####
Email *
How do you prefer us to contact you? *
Text Message on our cell phone
Email
**We will only communicate through email or text message in the interest of time and efficiency. PLEASE NO PHONE CALLS! Thank you :)
What City do you live in? *
Bismarck
Mandan
Lincoln
Other
APPOINTMENTS ARE ONLY FOR STUDENTS KINDERGARTEN THROUGH HIGH SCHOOL
Please provide the following information for children who will be attending the event.

CHILDREN MUST BE PRESENT AT THE APPOINTMENT TO BE SERVED!
ALL INFORMATION IS REQUIRED FOR EACH CHILD
Child 1
Child's Name (Kindergarten - Highschool ONLY) *
Child's Birthdate *
MM / DD / YYYY
Please select your child's grade. *
Please select your child's school *
Child 2
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 3
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 4
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's school
Please select your child's grade.
Child 5
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 6
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 7
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 8
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 9
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
Child 10
Child's Name (Kindergarten - Highschool ONLY)
Child's Birthdate
MM / DD / YYYY
Please select your child's grade.
Please select your child's school
- - - - - - - - - - - - - - - - - - - - - - THANK YOU!!! - - - - - - - - - - - - - - - - - - - - - - -