To enroll your child in the next session of the Healthy Kids Program, please complete and submit the registration form below. You will receive a confirmation by email. If you have any questions about the program, please call 928-336-7958.

"*" indica campos obligatorios

Child's Name*
Fecha de nacimiento*
Dirección*
Known Allergies:
Column 1
Column 2
Column 3
 
Parent/Guardian Name*
Program Waiver*
Photo Release