Lighthouse Kids Spectacular
Registration Form for 2019 (One Per Child)
Child's Full Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Child's Age and Grade *
Your answer
Parent(s) Name *
Your answer
Other Guardians (Who Pick up the Child)
Your answer
Address, City, Zip *
Your answer
Emergency Cell Phone # *
Your answer
Other Cell Phone #
Your answer
Email Address *
Your answer
Religion and/or Home Church
Your answer
Allergies and/or Special Instructions
Your answer
Submit
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