Child’s Full Legal Name
What Tomorrow's Topkids Clubhouse is your child currently enrolled at?
At Tomorrow's Topkids, safety is our number one priority. We need your help to make sure your child's experience is both fun and safe. Detailed information for all allergies, intolerance, or sensitivities listed on a registration form are required to be kept on file. Please complete a separate form for each allergy, intolerance, or sensitivity listed on your child's registration. Parent initial:
I understand that medication including, but not limited to: Benadryl, bug bit relief, Tylenol, etc. cannot be on site without additional forms signed by a physician. YesNo
My child has an: AllergyIntoleranceSensitivity
Does your child require any medication to be administered for this Allergy, Intolerance, or Sensitivity? YesNo
My child is allergic, intolerant, or sensitive to:
Please describe IN DETAIL, your child's allergic, intolerant, or sensitivity reaction to INGESTION (please put N/A if not applicable):
Please describe IN DETAIL, your child's allergic, intolerant, or sensitivity reaction to TOUCH (please put N/A if not applicable):
Please describe IN DETAIL, your child's allergic, intolerant, or sensitivity reaction to SMELL (please put N/A if not applicable):
Is there any other information about this allergy, intolerance, or sensitivity that you would like our staff to be aware of (please put N/A if not applicable):
EMERGENCY PLAN: Please describe in detail the steps you would like our staff to follow should your child have a reaction. Please note: if any medication (such as Benadryl, bug bite relief, Tylenol, etc.) is listed in your emergency plan, additional forms will be required to be completed by a physician.
Parent's Name
Cell Phone Number
Email Address
Date Completed
Δ
