Child's Name: (first & last) 

Child's Age:   

If in school, indicate last grade attended:

If preschooler, check last class attended:

     4K
     5K
   
Child's Birthday: (MM/DD/YEAR) 

T-Shirt
Youth Size:                                Adult Size:
     Youth XS (2-4)                   Adult Small  
     Youth S (6-8)                      Adult Medium
     Youth M (10-12)                 Adult Large
     Youth L (14-16)                  Adult X-Large
                                                       Adult XXL
                                                       Adult XXXL
    
Medical Information
 Medical or other information we need to know
 (Please include any food allergies.)
  

 Emergency Contact:

 Name:  

Phone Number: 

 Name:  

 Phone Number: 

Mother' Name: 

Mother's Email:  

Best Phone Number to Contact Mother:  

Father's Name:   

Best Phone Number to Contact Father:

Father's Email:    


Address:  

Where do you attend church?
 

 By printing your name in this box, you are giving permission 
 to the directors to secure proper treatment and/or
 hospitalization for your child for these days, June 21-25, 2010.  
 

Date: (MM/DD/YEAR)