MAN Boot Camp Registration

Child Name*
First Last
Child's Date of Birth*
Father's Name*
Prefix First Last
Father's Phone
Mother's Name*
Prefix First Last
Mother's Phone
Email
Address*
Street Address Address Line 2 City State ZIP Code
Photo ID of parent
Accepted file types: jpg, gif, png, pdf.
Additional information about your child.*
Medical conditions / Health concerns Medications - when to take them Allergies Special needs Tendencies
Emergency Contact Name
Prefix First Last
Emergency Contact Phone*