Child Activity License Application Form

Child Activity License Application Form
Submit your request for a child activity permit using this form.
Child's Full Name
First NameLast Name
Child's Date of Birth
MonthDayYear
Date
Parent/Guardian Full Name
First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Activity Name
Activity Location
Activity Start Date
MonthDayYear
Date
Activity End Date
MonthDayYear
Date
Emergency Contact Name and Phone Number
Should be Empty: