Wednesday Night Registration and Van Release
Van authorization and class room assignment
Email *
Student name *
Address *
Student Birthdate *
MM
/
DD
/
YYYY
What grade is your student currently in? *
Required
Allergies *
Parent Name *
Good Contact Number *
Email Address for updates
Emergency Contact (other than parent) *
Emergency Contact's Number *
How will your student get to Church? *
Required
Who is allowed to pick your student up? *
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