POLAR BLAST REGISTRATION FORM
Event Timing: January 9th, 2018 - February 27, 2018
Event Address: Mahomet United Methodist Church
Contact us at krobinson@mumc.org or 217-417-2994
Child's name *
Your answer
Child's age *
Your answer
Date of Birth *
Your answer
Current Grade *
Your answer
Name of parent(s) *
Your answer
Street Address *
Your answer
City *
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State *
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Zip *
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Home Phone Number *
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Parent/Caregiver's cellphone *
Your answer
Home Church *
Your answer
Allergies or other medical conditions
Your answer
In case of emergency, contact *
Your answer
Phone *
Your answer
Relationship to Child *
Your answer
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