If you would like to register your child for Lake Center's children's program, you can do so at the registration desk or by using this form. Once the registration form has been submitted, name tags will be created for your children and for you. Name tags will be discarded if child is absent for 12 consecutive weeks. Please email Amy Powers or Mark VanderKlok if you have any questions.

Parent / Gaurdian Name
Email Address
Home Address
Telephone Number
Cell Phone Number
Emergency Contact Name
Emergency Contact Phone
List all of your children's names
List D.O.B. (in same order)
List Grade (in same order)
List Allergies (in same order)
Attendence	Weekly Fairly Regular On Occasion Just Visiting
List other people who have permission to pick up your children
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