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Participant Registration
*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)
* Required