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Wednesday Night KIDZ Current
pre-school thru 5th grade
*
Indicates required field
Child's Name
*
First
Last
Pre-School age & K-5 Grade Child is currently in
*
3 year old
4 year old
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Parent/Guardian Name
*
Cell Phone Number
*
Begins Feb. 1st
Meal: 5:30 // Program:6:30-7:45
Address
*
City
*
State
*
Zip Code
*
Parent/Guardian Email
*
Child's Food Allergies
*
Emergency Contact Name
*
Emergency Contact Phone #
*
Emergency Contact Relationship to Child
*
Other Allergies or Medical Conditions
*
May we have permission to photograph and/or video your child for use in church publications?
*
Yes, you have permission to photograph/video my child.
No, I do not give permission to photograph/video my child.
Submit