*Your Relationship to Child:
Other Parent Relationship to Child:
Health And Allergy Information
Please list any allergies, health conditions, or allergic reactions
Provide information for two emergency contacts other than the parents.:
*Emergency Contact 1 Address:
Special Pickup Instructions:
*Is there court order restricting visitation of your child by a person? If yes, please list their names and relationship.
Both parents are legally allowed to pickup the child unless a court order is specified above. However, if you would like to give permission for aunts, uncles, grandparents, baby sitters, etc. to pickup your child, please complete the authorized pickup form for each person.
Add an authorized pickup for my child.
By submitting this registration, you are affirming that all information is correct to the best of your knowledge, and you agree to promptly notify the Great Escape Director's office of any changes to this information.