5 Week session registration | Sonoma County Ada 11

Register for a 5 week session! • Children ages 5–12. Please speak directly with a staff member about any immediate safety concerns before participation.

Child's full name

Age

Date of birth

Month

Day

Year

Parent/guardian name

Relationship

Home address

Allergies

Session location- Sports Basement, Santa Rosa

Wednesdays from 4:00pm-5:00pm- 11/4, 11/11, 11/18, 12/2, 12/9 * No session 11/25

Wednesdays from 5:15pm-6:15pm- 11/4, 11/11,11/18,12/2,12/9 * No session 11/25

Thursdays from 4:00pm-5:00pm- 11/5, 11/12, 11/19, 12/3, 12/10 * No session 11/26

Age groups will be determined based on registration. All attempts will be made to follow the SCASC age group model mini (5-6), Junior ( 7-9), Youth ( 10-12) Please indicate which group your child is registering for.

Medications relevant to participation

Medical conditions/considerations

How can we best support your child?