CHILD REGISTRATION (Please complete this form for each child under the age of 18 attending.)

Child's Name

Child's Gender

Child's Age

Birth Date

Last School Grade Completed

Attending Dinner

Parent(s) Name

Street Address

City

Zip Code

Primary Phone Number

Parent Cell

Parent Email

Home Church

Allergies, medical conditions, or special needs:

Emergency Contact Name:

Relation to the Child

Emergency Contact Phone Number: