Fishburn Flock

This form is only for participants that are enrolled in the Fishburn Flock Childcare Center.
Please complete this form and payment for each participant, apologies for the inconvenience.

One-time payment will cover 6 weekly sessions beginning the week of July 8, 2024 and finishing the week of August 12, 2024.

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Email
Your receipt will be email to this address.
Parent/Guardian Name
Emergency Contact Name

Participant Information

Participant Name
Release of Liability
Photo Release
As a new company, your consent to use photographs of this group would be greatly appreciated.

Secure Payment

Price: $90.00
Price: $0.00

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