Milk 'n' Cookies Online Registration

Please fill out the form once for each child you are registering. Please, no children older than seven or younger than two.

Family Info
Child's name:
Parents' names:

Home phone: Work phone:

Home address:

Allergies/Medications:

Emergency Contact
Relationship to child:

If not same as parents:
Name:
Phone number:

Days Attending
All three days
or
Selected days:
Thursday, June 10, 1999
Friday, June 11, 1999
Saturday, June 12, 1999

Fees
Child per day all days
first child from a family $9 $25
each additional child from the same family $7 $20
Make checks payable to:

	Child	per day	all days
first child from a family	$9	$25
each additional child from the same family	$7	$20

Jordan Franklin
5847 Sandstone Dr.
Durham, NC 27713-1925

Thank you!