Venture Club 2018-2019

Child's Name *
First Name
Middle
Last Name
Please select your child's current grade. *
Mailing Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Email*
Child's Gender *
Child's Birthdate*
School Child Attends*
Parent / Guardian Names*
Please provide a number where each parent can be reached.
Mom's Phone Number*
Dad's Phone Number*
In case of emergency who do we notify?
Name*
Number*
Is your child on any medication or does your child have any allergies? *