*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) |
Comments: |
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