May 2013
S	M	T	W	T	F	S
28	29	30	1	2	3	4
5	6	7	8	9	10	11
12	13	14	15	16	17	18
19	20	21	22	23	24	25
26	27	28	29	30	31	1
2	3	4	5	6	7	8

	Event Registration
	*Events You Are Registering for:	Star Ship Dinner Cruise, August 20th, 5:30pm-10:30pm $25.00

	Student Information
	*First Name:
	*Last Name:
	*Date of Birth:
	*School:
	*Grade:
	*Cell Phone:
	*Email:
	*Verify Email:
	*Shirt Size:

	Parent Information
	*Parent's First Name:
	*Parent's Last Name:
	*Home Phone:
	*Work Phone:
	*Parent's Cell Phone:
	*Address:
	Apt #:
	*City:
	*State:
	*Zip:


	Emergency and Medical Information
	*Emergency Contact:
	*Emergency Phone:
	*Name and relationship of person dropping off/picking up student from event:
	Does student have allergies or dietary restrictions? If so, please list.
	In emergency situations, are there any medications the student takes? If so, please list. (Note: we cannot administer medications)
	Please list any medical conditions or special needs.
	*Required Fields

Check out our Calendar for upcoming events