WELCOME TO GATEWAY LAS VEGAS!

Please fill out this form so we can add your child to our check-in system.
We look forward to getting to know your family!

Parent's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Please contact me by:

Email

Phone

Mail

Do you have a custody issue we should be aware of?

No

Yes

If so, please specify:

Child's Name

Age & Date of Birth

Allergies

Child's Name

Age & Date of Birth

Allergies

Child's Name

Age & Date of Birth

Allergies

Child's Name

Age & Date of Birth

Allergies