*Participant's First Name: |
__________________________________ |
*Participant's Last Name: |
__________________________________ |
*Parent/Guardian Name: |
__________________________________ |
*Address: |
__________________________________ |
*City: |
__________________________________ |
*State: |
__________________________________ |
*Zip: |
__________________________________ |
Home Phone: |
(______)______-________ |
Cell Phone: |
(______)______-________ |
*Birthday: |
__________________________________ |
By the end of May of this year... |
*Last Grade Completed: |
__________________________________ |
Allergies, Medical, & Special Needs: |
|
*Emergency Contact Name (1): |
__________________________________ |
*Emergency Contact Phone (1): |
(______)______-________ |
Emergency Contact Name (2): |
__________________________________ |
Emergency Contact Phone (2): |
(______)______-________ |
*Will your child be riding the bus?: |
|
*I.D. Required: |
I understand and agree. I do not agree. (circle one) |
*Authorized Pickup #1: |
__________________________________ |
Authorized Pickup #2: |
__________________________________ |
Authorized Pickup #3: |
__________________________________ |
Do you attend Church?: |
Yes No (circle one) |
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: |
__________________________________ |
*Track choice #2: |
__________________________________ |
*Track choice #3: |
__________________________________ |
*Track choice #4: |
__________________________________ |
Comments: |
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