First Name

Date of Birth

T-shirt size

Last Name

Grade entering in the Fall

Name of a friend your child might like to be with

Allergies or Medical Conditions we should be aware of

First Name

Last Name

Mailing Address

Mailing City

Mailing Zip Code

Mailing Address Line 2

Mailing State

Mobile Number

Alternate Number

Email Address

Do You Have a Home Church?

If Yes, what is the name of your church?

First & Last Name

Relationship to child

Phone Number