Student Information

* 1. Student First Name

* 2. Student Last Name

* 3. Student Age

* 4. Student Date of Birth (MM/DD/YYYY format)

Date of Birth

* 5. Student Grade

* 6. Please place my child with: (We will make every effort to honor requests, as long as the group is age appropriate. Please note: we can only move a child DOWN to a lower age group. We cannot move a child up in age to be with an older friend.)

* 7. Home Church

* 8. Food Allergies (leave blank if none)

* 9. Other Allergies/Medical Conditions/Special Instructions or Needs (leave blank if none)

* 10. Doctor's Information (Optional)

* 11. Student will be walking from the neighborhood to Adventure Week

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