Moppets Registration Form Child's Name First Last Birth Date MM slash DD slash YYYY Mother's Name First Last Mother's Phone NumberMother's Email Father's Name First Last Father's Phone NumberWho has permission to pick up your child in the case of an emergency? Please list at least three names with phone numbers.Doctor's Name First Last Doctor's Phone NumberFavorite toys, songs, games, foodSpecial InstructionsEmailThis field is for validation purposes and should be left unchanged. Δ