PABC Wednesday Night Ignite Kids Registration
We request that each family register their children so that we will have emergency contact information.
* Required
Parent Info
Primary Parent
*
Your answer
Phone number
*
Your answer
Email
Your answer
Address (Street, City, State, Zip)
*
Your answer
Secondary Parent
Your answer
Phone number
Your answer
Email
Your answer
Address (Street, City, State, Zip)
Your answer
Comments: special instructions and/or others who are authorized to pick up your child
Your answer
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