Wufoo

Name of Child * First Last
Age of Child *
Name of Child First Last
Age of Child *
Name of Child First Last
Age of Child *
Name of Child First Last
Age of Child *
Name of Child First Last
Age of Child *
Parent/Guardian Name: *
Address *
Home Phone Number *
Cell Number *
Family Doctor Number *
Emergency Contact Name *
Relationship to Child *
Health Concerns? *
Food or Environmental Allergies? *
Preferable Pizza Choices *

We will be ordering pizza for dinner. Please choose which pizza your child will prefer. We will order gluten free upon request.
My child has permission to attend Maverick Dance Team Babysitting Night. I have no knowledge of any physical impairment that would affect or be affected by my child’s participation in the service. In the event of an emergency in which my child requires medical care, I authorize the staff of Maverick Dance Team to obtain for them whatever medical treatment the staff, in its best judgment, deems necessary and appropriate. I specifically waive and release the staff of Maverick Dance Team and Northwest Tech from liability of any claim for damages that my child or I may have for the inquires they may sustain at the babysitting event. *
Agree Disagree
Electronic Signature of Parent/Guardian: * First Last
Do Not Fill This Out