T4T Program Registration Form

Signing up for 3 or 6 month program, your child will receive the following:

Backpack
Water Bottle
Buff
Whistle

Signing up for 1 month program, your child will receive the following:

Water Bottle
Buff
Whistle

Child's Information

Full Name

Date of Birth

Age

GenderMaleFemale

Street Address

City

State/Province

Country

Parent/Legal Guardian Information:

Full Name

Email Address

Phone

Emergency Contact Information

Full Name

Phone

Relationship

Medical Information

Does your child have any medical conditions or allergies that we should be aware of?

Program Information

Payment Options

Tots (4-8yrs old)

Kids (9-12yrs old)

Teens (13-17 yrs old)

1 Month

$100

$125

3 Month

$275

$300

6 Month

$525

$575

Which program option do you choose?

NOTE: If online, typing of name in “Print” and “Sign” fields act as identity verification.

Signature[Parent/Guardian Name]

Date

Signature[Child’s Name]

trails 4 tots

T4T Program Registration Form

Child's Information

Parent/Legal Guardian Information:

Emergency Contact Information

Medical Information

Program Information

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