2019 Christmas Registration Form
Shiloh Community Development Corporation

**ONE REGISTRATION PER CHILD**
Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Age *
Your answer
Child's Grade *
Child's Sex *
Child's School *
Your answer
How did you find out about the Shiloh Community Christmas Event? *
Media Waiver --- I Give permission for the Shiloh CDC, Shiloh Baptist church and/or designated representative the unrestricted right to photograph, audio record or videotape me or my child name, voice, appearance, likeness and comments about the Community Christmas Celebration and Toy Give-away for promotional purposes *
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