Does child have any special needs? (Yes or No) If yes, will your child need a one on one buddy? Please reach out to Michelle Maris if you need details. *
Your answer
Please list allergies and/or other health concerns: *
Your answer
Emergency Contact Person Name, Relationship to Child and Phone Number: *
Your answer
Health Insurance Provider, City and Phone Number: *
Your answer
Family Doctor Name, Location and Phone Number: *
Your answer
Family Dentist, Location and Phone Number:
Your answer
T-shirt Child Size: *
I give permission to Atlanta Christian Church to take pictures, video and/or post on sociaal media images of my child: *