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Pre-Registration Form

Register each child separately. (Fields marked with * are required)

* Child's First Name * Child's Last Name

* Child's Age Child's Gender

* Child's Address

* City * State * ZipCode

Phone number Parent's Email

Mother's Name Mother's Phone

Father's Name Father's Phone

Emergency Contact Information

* Emergency Contact Name * Emergency Contact Phone

* Relationship to Child

Insurance Company Policy Number


Does this child have any allergies, disabilities, present injuries/limitations, or any other significant medical conditions?
If yes, please explain.

Additional Information

How many years has the child attended Sports Jam in the past?

How did you hear about Sports Jam?

Home Church?

Do you give permission for Sports Jam to contact you via email?