The Dare to Care Kids Club
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Dare to Care Kids Club - 2022 Application
First Name 
Age 
Last Name
Home phone
Zip code
State
Grade 
City
School
Address
Mother's Name
Cell Phone 
Emergency Contact 1
Work phone
Email 
Cell phone
Father/Guardian's Name
Address
City
State
Zip code
Home phone
Cell phone
Work phone
Email 
Emergency Contact 2
Cell Phone 
Physician's Name 
Phone 
Medical Card No. 
Permission to administer medicine?
Additional Children?? Add their information here. 
First Name 
First Name 
Last Name
Last Name
Age 
Age 
School
School
Grade 
Grade 
Grade 
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