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IMP for Kids
imp4kids@gmail.com
IMP REGISTRATION FORM
Child's Name
First Name
Last Name
Child's Age and Grade
Parent's Name
First Name
Last Name
Email
Phone Number
Alternate Parent's Name
First Name
Last Name
Phone Number
Mailing Address
Street Address
City
State
Zip
Island Address
Street Address
City
State
Zip
Emergency Contact Name and Phone Number
Please sign my child up for:
Choose One
SUMMER Session #1 (One Week)
SUMMER Session #2 (One Week)
SUMMER Session #3 (One Week)
SUMMER Session #4 (Two Week)
SUMMER Session #5 (Two Week)
IMP CAMP Morning Drop In
IMP CAMP Afternoons
AFTER SCHOOL Session #1
AFTER SCHOOL Session #2
MINI Session (5 Weeks)
IMP PLAY DATE
Does your child have any issues you would like to let us know about that would make them more successful in our program?
I give my permission for IMP for Kids to adminster first aid to my child.
Yes
No
I understand that my application is not complete until payment has been received.
Yes
No
You will recieve an email within 24 hours from the Director. If you do not recieve an email please contact us.
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