Emmaus Childrens' Ministries Registration
Last Name of Child(ren) *
Your answer
Parent Names *
Your answer
Mailing Address *
Your answer
Emergency Contact Name (if parents not available) *
Your answer
Emergency Contact Phone Number *
Your answer
Please list children (ages infant through 5th grade) in your household.
Child Name *
Your answer
Birth Date: (mm/dd/year) *
Your answer
Grade in '16-'17 *
This child will participate in the following (check all that apply):
Child Name
Your answer
Birth Date: (mm/dd/year)
Your answer
Grade in '16-'17
This child will participate in the following (check all that apply):
Child Name
Your answer
Birth Date: (mm/dd/year)
Your answer
Grade in '16-'17
This child will participate in the following (check all that apply):
Child Name
Your answer
Birth Date: (mm/dd/year)
Your answer
Grade in '16-'17
This child will participate in the following (check all that apply):
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