Child Registration Form
Dates: July 8th-12th
Time: 9am-12pm
Child's Name *
Your answer
Child's Gender *
Age
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last Grade Completed *
Your answer
Name of Parent(s) or Legal Guardian(s) *
Your answer
Address *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Email Address
Your answer
Name of Home Church
Your answer
T-shirt Size: *
Required
Friend with whom my child would like to be grouped, if possible:
Your answer
Please list all individuals who have permission to pick up your child: *
Your answer
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