Lexington Baptist Church - Special Needs Ministry Respite Event - Saturday, March 21, 2020 - 10:00am-1:00pm
Please complete before arrival for the scheduled event. These questions are asked for the benefit of your child and so that we may provide the best experience and safest environment for everyone involved. Any information shared on this form is communicated directly with those caring for your child and only on a "need to know" basis.
Email address *
Participant Full Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Age *
Your answer
Will any siblings be joining them? If so, include name, age and any special instructions or allergies.
Your answer
Parent Name *
Your answer
Cell Number *
Your answer
Email Address *
Your answer
Home Address
Your answer
Other Persons Authorized to Pick Up Child
Your answer
Emergency Contact (Full Name & Contact Number) *
Your answer
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