Child Registration Form
Dates: July 20-24th
Time: 9am-12pm
Location: Wellspring Baptist Fellowship
Child's Name *
Child's Gender *
Age
Date of Birth *
MM
/
DD
/
YYYY
Last Grade Completed *
Name of Parent(s) or Legal Guardian(s) *
Address *
Home Phone *
Cell Phone *
Email Address
Name of Home Church (if applicable)
Friend with whom my child would like to be grouped, if possible:
T-shirt Size: *
Required
Please list all individuals who have permission to pick up your child: *
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