2015 Mall Registration

Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Parent or Guardian *
Parent or Guardian
Main Contact
Main Contact
Secondary Contact *
Secondary Contact
Secondary Contact
Secondary Contact
*NOTE: Photo ID may be required to pick up children. Please list no more than 4 individuals
These pictures may be used in internal promotions or on our social media channels
Digital Signature *