| *Participant's First Name: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Preferred Name for Name Tag: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *Birthday: |
__________________________________ |
| Is your child 4 years of age before July 1?: |
Y (circle one) |
| *T-Shirt Size: |
__________________________________ |
| *Grade in September: |
__________________________________ |
| *Last Grade Completed: |
__________________________________ |
| Buddy Request: |
__________________________________ |
| If 7th-12th grader 1st choice volunteer position: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| Parent volunteering: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Primary Phone: |
(______)______-________ |
| Work Phone: |
(______)______-________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| Allergies, Medical, & Special Needs: |
|
| Does your child have an EpiPen?: |
Y (circle one) |
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| Emergency Contact Name (2): |
__________________________________ |
| Emergency Contact Phone (2): |
(______)______-________ |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Authorized Pickup #3: |
__________________________________ |
| Authorized Pickup #4: |
__________________________________ |
| Are you a member of this church?: |
Yes No (circle one) |
| *What Parish do you attend?: |
__________________________________ |
| May we have permission to photograph your child?: |
Yes No (circle one) |
| May we have permission to use your child's photograph in church publications?: |
Yes No (circle one) |
| Comments: |
|
