Kayak Trip on the Mustinka

Child Information

Child's Name

Child's Gender

Male Female

Child's Birthday

Grade this fall

5th 6th

Student Phone

Allergies or other medical conditions

Parent/Guardian Information

Parent(s)/Guardian(s) Names

Parent/Guardian Phone

Parent/Guardian Email

This address will receive a confirmation email

Address

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Relationship to Child

Description

July 14, 2021

This kayak trip is for anyone entering 5th & 6th grade in the Fall of 2021. Please fill out this form and click submit if you are going to be attending! Please fill out one form for each child if you are filling this out for more than one child.

Kayak Trip on the Mustinka

Description

Please Fix the Following