ROAR Registration Form

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ROAR Registration Form

August 5-9, 2019
Wetzel Road Church of Christ
Contact us at (315) 652-3195

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* Indicates required question

Child's Name *

Your answer

Child's Gender *

Female

Male

Child's Age *

Your answer

Child's Date of Birth *

MM

/

DD

/

YYYY

Last School Grade Completed *

Your answer

Parent's Name(s) *

Your answer

Street Address *

Your answer

City *

Your answer

State *

Your answer

ZIP *

Your answer

Home Telephone

Your answer

Parent's Cell Phone *

Your answer

Parent's Email *

Your answer

Home Church

Your answer

Allergies or other medical conditions (If none, please designate so) *

Your answer

Emergency Contact Name *

Your answer

Emergency Contact Phone *

Your answer

Relationship to Child *

Your answer

Submit

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