registratiON fOrM
(One Per Child)
Child’s name: Child’s gender:
Child’s age: Date of birth: Last school grade completed:
Name of parent(s):
Street address:
City: State: ZIP:
Home telephone: ( )
Parent/caregiver’s cellphone: ( )
Home email address:
Home church:
Allergies, medical conditions, or special needs:
In case of emergency, contact:
Phone:
Relationship to child:
Crew number or name (for church use only):
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