*1.Name of Participating Child(Required.)

*2.Child Age(Required.)

*3.Current Grade Level(Required.)

*4.Name of Parent and/or Guardian(Required.)

*5.Address(Required.)

*6.Phone Number(Required.)

*7.Does your child plan to participate in the church Christmas program on Sunday, December 14 at 10:30 AM?(Required.)

Yes

No

*8.Does your child have any food allergies we should be aware of during their participation?(Required.)

No

Yes (please specify)

9.Is there any other information you’d like to share with us about your child?

*10.Additional emergency contact - name & phone number(Required.)