C.R.O.W.N. Registration
C.R.O.W.N. SUMMER RECREATION PROGRAM
FOR STUDENTS going into KDG—6th grade!
Beginning May 20th— August 16th
802 Winter St. Wakefield, NE 68784
402.287.2692
Email address *
Student’s Name/ Nombre de Estudiante *
Your answer
Parents name/ Nombre des Padres: *
Your answer
Phone Number/namero de teléfono: *
Your answer
Secondary Contact/ Contacto Secundario : *
Your answer
Secondary Contact Phone Number/ Contacto Secundario namero de teléfono: *
Your answer
EMERGENCY CONTACT/ Contacto de emergencia *
Your answer
EMERGENCY CONTACT Phone number/ Contacto de emergencia teléfono: *
Your answer
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This form was created inside of Wakefield Covenant Church. Report Abuse