**Each child requires a separate registration form** Participant InformationChild's Name(Required) First Last Child's Age(Required)Child's Birthday(Required) MM slash DD slash YYYY Sex(Required)MaleFemaleAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Child's T-Shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeFamilyPlease check to indicate the parent to contact for payment and other questions.Preferred ContactMother/GuardianFather/GuardianMother/Guardian Name(Required) First Last PhoneWork PhoneMother/Guardian Email Address(Required)EmployerFather/Guardian Name(Required) First Last PhoneWork PhoneFather/Guardian Email Address(Required)EmployerEmergency ContactIf Parent or Guardian cannot be reached1st Option Name First Last 1st Option Relationship to ChildCell PhoneAlternate Phone2nd Option Name First Last 2nd Option Relationship to ChildCell PhoneAlternate PhoneAuthorized to Pick UpMust be 18 years or older and provide a safe word or photo ID.Name First Last Relationship to ChildName First Last Relationship to ChildName First Last Relationship to ChildPlease choose a personal code for pickup(Required)If you must send someone whom you have not placed on your authorized list to pick up your child, please call the program director at (864) 938-2795. A photo ID is required for pickup.How did you hear about Momentum?
