SUMMER FUN Dance for Exceptional Kids
Friday, June 16, 2017, 7:00-8:30pm Register Participants 10 years of age and older
Participant's Name
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Participant's Age as of the event
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Parent/ Guardian Name
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Parent/Guardian Email Address
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Parent/Guardian Phone Number
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Emergency Contact Name, Relationship
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Emergency Contact Phone Number
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Does the Participant have any food allergies or restrictions? If yes, please explain.
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Does the Participant have sensory difficulties? If yes, please explain.
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Permission is given by my electronic signature allowing Johns Creek United Methodist Church to post photos of my child/youth/family in media-based presentations and events that highlight various activities and events occurring during the course of the year.
Electronic Signature
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