Child's Name *

Child's Name

if you are registering more than one child, please list additional names in the next field

First Name

Last Name

Children's names

Parent's name *

Parent's name

First Name

Last Name

Parent's Email Address *

Children's date of birth and grade in school *

Please list each child on one line

Home Address *

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Phone *

Parent's Phone

(###)

###

####

Allergies or other conditions we should be aware of *

physical limitations, ADHD, learning disability, etc.

Emergency contact person and phone number *

I am available to help as

Additional Comments

Release for photography

The church may take pictures or video for use in publications, on the website or on our Facebook page. Please check what permissions you give:

Address

Contact