ZIP 2022
If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

If you have previously registered with us for a prior event, you can search for your stored information instead of filling out the form below.
Personal Information
*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
Home Phone:
(555-555-5555)
Cell Phone:
(555-555-5555)
*Birthday:
(MM/DD/YYYY)
By the end of May of this year...
*Last Grade Completed:
Allergies, Medical, & Special Needs:
(Leave Blank if None)
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
Emergency Contact Name (2):
Emergency Contact Phone (2):
(555-555-5555)
*Will your child be riding the bus?:
(If so, what address to pick up/drop off? A bus route schedule can be found on our website at www.farleycc.org, or call the church office at 880-3878)
*I.D. Required:
(If your child is not riding the bus, a valid driver’s license of someone on the authorized pick up list will be required to pick up all car riders at noon.)
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Do you attend Church?
If so, where?
Have your child choose 4 of the following tracks, with the first one being their most favorite. Two of your child's favorites will be his/her tracks for the week.
*Track choice #1:
(Your child's first choice:)
*Track choice #2:
(Your child's second choice:)
*Track choice #3:
(Your child's third choice:)
*Track choice #4:
(Your child's forth choice:)
Comments:
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