2019 Christmas Registration Form
Shiloh Community Development Corporation

**ONE REGISTRATION PER CHILD**
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Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Email Address *
Child's First Name *
Child's Last Name *
Child's Age *
Child's Grade *
Child's Sex *
Child's School *
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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