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MC3 Church Children's Registration Form
Please complete this form to preregister your child for our database. If you have any questions, contact Rae Tyler Caggiula at caggiula@mc3.life.
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Child's Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Age
Your answer
School
Your answer
Grade
*
Your answer
Preferred Emergency Contact Number
*
Your answer
Mother's Name
*
Your answer
Mother's Cell Phone Number
*
Your answer
Mother's Email Address
*
Your answer
Father's Name
*
Your answer
Father's Cell Phone Number
*
Your answer
Father's Email Address
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Allergies/Special Needs
Your answer
Guest of
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Check box if first-time visitor
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