GoKids Boston

Registration

Registration
Clinician's Quick Referral

Registration

Parent or Guardian's Name:
Address:
City:
State:
Zip Code:
Phone number (home):
Phone number (work):
Phone number (cell):
Programs interested in:	General Membership Summer Camp Packs of "Play Passes" Personal Training
Email address (home, work):	(E-mail)
Child/childrens' name(s):
How did you hear about our program? :
Referrer's Name:

* required fields

A member of our staff will contact you to discuss enrollment in our exciting programs. Thank you for taking the time to fill out this form.

Please note: you must be either a parent or legal guardian to fill out this form.

GoKids™ Boston™ is supported by Children’s Hospital Boston, by the University of Massachusetts Boston, by generous donors and grants, and by participants in its programs.