Family Information
Name of Primary Member (Parent or Legal Guardian) *
Name of Primary Member (Parent or Legal Guardian)
Address *
Address
Phone *
Phone
Please register all parents, caregivers, any other adults who will be bringing the child to Curiosity, and children below:
Adult #1
Adult #1
Adult #2
Adult #2
Adult #3
Adult #3
Adult #4
Adult #4
Adult #5
Adult #5
General Information
Children: (please include date of birth and sex)
Children #1
Children #1
DOB
DOB
Sex
Children #2
Children #2
DOB
DOB
Sex
Children #3
Children #3
DOB
DOB
Sex
Children #4
Children #4
DOB
DOB
Sex
Children #5
Children #5
DOB
DOB
Sex
Name of Physician *
Name of Physician
Physician's Address *
Physician's Address
Physician's Phone Number *
Physician's Phone Number
Emergency Contact #1
Emergency Contact #1
Emergency Contact #2
Emergency Contact #2
Medical Information
Does your child have any allergies, physical limitations, or medical conditions you would like us to know about? Please describe:
Agreement
Liability Waiver and Hold Harmless Agreement *
Please read the Agreement by clicking the "LIABILITY WAIVER AND HOLD HARMLESS AGREEMENT". By selecting the "I AGREE, I have READ and UNDERSTOOD the Liability Waiver and Hold Harmless Agreement." box you accept our Liability Waiver and Hold Harmless Agreement.