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Registration for Christmas for Kids on Dec. 8; ages 4 (if potty trained) thru 4th grade

Parent(s) Name(s)*
Address of Child(ren)*
City*
Zip code*
Home Phone #
Emergency Phone Contact (if different from previous phone number)
Name of Person Verifying Information*
1. Name of Child*
Age of Child*
Current Grade of Child*
Does this child have special needs (e.g. allergies)? If so, please specify
2. Name of Child
Age of Child
Current Grade of Child
Does this child have special needs (e.g. allergies)? If so, please specify
3. Name of Child
Age of Child
Current Grade of Child
Does this child have special needs (e.g. allergies)? If so, please specify
4. Name of Child
Age of Child
Current Grade of Child
Does this child have special needs (e.g. allergies)? If so, please specify
Do you currently have a church home?
If so, please specify


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