Rachel Kurtz Youth Connection Event
For youth in GRADES 6-12
Event Address:  2800 N. Church Road, Liberty, MO 64068
Contact us at (816) 781-7991 or chrismmarple@gmail.com

Please list first and last names and ages of all participants joining from your family (Grades 6-12):
*
Phone Number AND NAME of Parent/Guardian: *
Phone Number AND NAME of Emergency Contact: *
Will your children be staying for dinner and games (pizza, soda, water, and assorted snacks)?  5:30-6:45pm
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Will a parent be joining us for dinner? 
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What allergies or medical conditions do we need to be aware of?
How did you hear about this event? *
What Comments and/or Questions Do You Have? 
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