A Day @ Cyokamo Registration Form
Community Christian Church - Fort Scott, KS
This event is on Thursday, August 6th for kids & students entering K-8th grades.

This is the official online medical waiver. By completing this form and signing digital you are agreeing to all permissions included.
Before you start, you will need your HEALTH INSURANCE & PHYSICIAN'S CONTACT INFO on section 2 of this form!
First Name *
Last Name *
Date of Birth *
Gender *
Address *
Student Cell Number
Student Email
Grade Entering Fall of 2020 *
Shirt Size (K-5th Grades Only):
Clear selection
Have you been baptized? *
Parent/Guardian #1 Name: *
Parent/Guardian #1 Phone: *
Parent Guardian #1 Email: *
Parent/Guardian #2 Name:
Parent/Guardian #2 Phone:
Emergency Contact Name: *
Emergency Contact Phone: *
Emergency Contact Relationship: *
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