Child’s Name:_
Street address:
City:
State:
ZIP:
Home telephone: ( )
Home e-mail address:
Age:
Date of birth:
Last school grade
completed:
In case of emergency,
contact:
Mother:
Father:
Other:
Allergies or other
medical conditions:
Home church:
______
Crew number (for church
use only):
Name of a special friend your child might like to
be with*:
(*We will do our best to accommodate
your requests – but cannot guarantee that friends will be on the same
crew. Your child will have
wonderful opportunities to make new friends and interact with a new group
of children!)
Please fill out 1 form
per child