| *Participant's First Name: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Preferred Name for Name Tag: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *Birthday: |
__________________________________ |
| *Was your child born before 9/1/21?: |
Y N (circle one) |
| *Grade Completion: |
__________________________________ |
| *T-Shirt Size: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| Work Phone: |
(______)______-________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Allergies, Medical, & Special Needs: |
|
| *Additional Question 1: |
Y N (circle one) |
| *Additional Question 2: |
Y N (circle one) |
| *Additional Question 3: |
Y N (circle one) |
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| *Emergency Contact Name (2): |
__________________________________ |
| *Emergency Contact Phone (2): |
(______)______-________ |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Are you a member of this church?: |
Yes No (circle one) |
| Guest of: |
__________________________________ |
| Do you attend Church?: |
Yes No (circle one) |
| *If so, where?: |
__________________________________ |
| *How did you hear about us?: |
__________________________________ |
| *How did you hear about us?: |
__________________________________ |
