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Shipwrecked Registration
PLEASE FILL OUT A SEPARATE REGISTRATION FOR EACH CHILD

Wednesday Nights 6-8 PM
August 29th - September 26th, 2018
6024 L Street, Lincoln, NE 68510
Contact us at (402)489-8896 office@firstcovenantlincoln.org

Parent Name(s) *
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Address *
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Phone Number *
Best number to reach you during the event in case of emergency
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Email Address *
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Name of Child *
Your answer
Age of Child *
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Grade in School this Fall *
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Food Allergies or other concerns *
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Home Church *
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