Storm Back Yard Bible Party Registration
Dates and Time: June 24-27, 6p-8:00p

Location: 7001 Round Prairie Street, Shawnee KS 66226

Who: For kids going into Kindergarten-5th Grade

Child #1 Name and Grade (2018-2019 school year) *
Your answer
Child #2 Name and Grade (2018-2019 school year)
Your answer
Child #3 Name and Grade (2018-2019 school year)
Your answer
Child #4 Name and Grade (2018-2019 school year)
Your answer
Child #5 Name and Grade (2018-2019 school year)
Your answer
Parent/Guardian Name and Email Contact *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Street Address, City, State and Zip *
Your answer
Church Attending
Please provide the names and phone #'s of friends or relatives that can pick up your child (if any)
Your answer
Is there anyone who can NOT pick up your child?
Your answer
Please list any food or medical allergies, medication being taken, medical problems, or any other information that would help us care for your child
Your answer
Do you give Mill Creek Community Church permission to take photographs of your child during this activity? *
Required
How did you hear about the Back Yard Bible Party? *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Mill Creek Community Church. Report Abuse - Terms of Service