Spark in the Park! Registration
June 12-14, 9:00am-11:30am, in Silver Lake Park (near the playground). Children age 3 - 5th grade welcome!
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Name *
Your answer
Birthdate *
MM
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DD
/
YYYY
Address *
Please type in house number, street, City and Zip
Your answer
Home Phone *
Phone numbers are for safety purposes only. You will not receive unsolicited calls. If your home number is your cell phone skip the next question and indicate "Cell" in your answer to this question.
Your answer
Cell Phone
Your answer
E-mail
Your answer
Parent(s)/Guardian(s) Name(s) *
Please indicate relationship to child
Your answer
Work Number
If this number is the best way to reach you while your child is at Spark in the Park.
Your answer
Emergency Contact *
Please share name - Relationship to Child - Best phone number
Your answer
Allergies - Medical Conditions *
Is there anything we should know about your child in order to care for them. Your child's safety is very important to us! If there is nothing we need to be aware of please type, "None"
Your answer
School grade recently completed *
If they are preschool age let us know.
Your answer
Name of your home church
If you do not have one please type "none"
Your answer
May we use pictures taken at Spark in the Park that have your child in them?
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