Child's name *

Birthday *

Age *

---4567891011

Grade completed *

Tshirt size *
---YSYMYLASAMALAXL

Church membership at

Parents' names *

Home address (include zip code) *

Parent email address *

Home phone *

Alternate phone

Emergency Contact

Emergency Phone

Food allergies *
NoYes

Medical concerns *
NoYes

Doctor's Name

Doctor's Phone