| *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: |
|
