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Participant Registration

*Participant's First Name:	__________________________________
*Participant's Last Name:	__________________________________
*Parent/Guardian Name:	__________________________________
*Address:	__________________________________
*City:	__________________________________
*State:	__________________________________
*Zip:	__________________________________
*Primary Phone:	(______)______-________
Work Phone:	(______)______-________
*Cell Phone:	(______)______-________
Email:	__________________________________
*Birthday:	__________________________________
*Last Grade Completed:	__________________________________
*Allergies or Special Needs:	__________________________________
*Emergency Contact Name (1):	__________________________________
*Emergency Contact Phone (1):	(______)______-________
*Authorized Pickup #1:	__________________________________
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)
T-Shirt Size:	__________________________________
Comments:
Gender:	Male  Female  (circle one)

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