Registration for our summer and fall sessions is now underway. You may submit your registration by simply filling out the form below, or you may print a copy of our registration form by going here.

Family Information

Child's Name:* 
Birthdate:* 

Child's Name: 
Birthdate: 

Child's Name: 
Birthdate: 

Address:* 
City:* 
State:* 

Zip:* 

Home Phone:* 
Cell Phone:* 
Email:* 

Mother's Name:* 

Employer: 
Work Phone: 

Father's Name:* 

Employer: 
Work Phone: 

Emergency Contact Information

In case of emergency, parents will be called first, unless you specify otherwise. Emergency contacts are in addition to parents.

Emergency Contact:* 
Relationship to Child:* 
Phone:* 

Emergency Contact: 
Relationship to Child: 
Phone: 

Medical & Additional Information

Child's Physician:* 

Physician's Office or Group Name:* 
Phone:* 

Does child have any known allergies? If so, explain.

Does child have any special needs? If so, explain.

Is child current on required immunizations?*  yesno

Do you wish to be contacted by Colonial Park Clergy at this time?  yesno

Which session are you registering for:*  SummerFall

Please indicate the days you have chosen:*  MondayWednesdayFriday

Electronic Signature

By entering my name below, I agree to submit the above document with an electronic signature.

Parent's Name:* 
Date:* 

For security reasons, please enter the following text into the field below

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