Kids Check In — Virginia COGOP

Kids Convention

Pre-Registration

Special Note: A child should be fever free (without any fever-reducing medicine), and have stopped experiencing diarrhea and/or vomiting for at least 24 hours before being admitted to Kids Convention. A child must be lice free for at least 48 hours. If you need to pre-register additional children, please submit this form and fill out an additional form. Thank you!

Parent Name

First Name

Last Name

Email

Phone

(###)

###

####

Child #1

First Name

Last Name

Date of Birth

MM

DD

YYYY

Child #2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Child #3

First Name

Last Name

Date of Birth

MM

DD

YYYY

Child #4

First Name

Last Name

Date of Birth

MM

DD

YYYY

Are there any allergies or medications we should be aware of?

Please list them