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Participant Registration
*Participant's First Name:  __________________________________
*Participant's Last Name:  __________________________________
*Address:  __________________________________
*City:  __________________________________
*State:  __________________________________
*Zip:  __________________________________
Student Cell Phone:  __________________________________
Student Email:  __________________________________
*Birthday:  __________________________________
*Grade:  __________________________________
Gender:  Male  Female  (circle one)
Allergies, Medical, & Special Needs:
*Parent/Guardian Name:  __________________________________
*Parent/Guardian #1 Cell:  __________________________________
*Parent/Guardian #1 Email:  __________________________________
Parent/Guardian #2 Name:  __________________________________
Parent/Guardian #2 Cell:  __________________________________
Parent/Guardian #2 Email:  __________________________________
*Emergency Contact (OTHER than parent) Name:  __________________________________
*Emergency Contact Phone:  __________________________________
Authorized Pick Up:  __________________________________
May we have permission to photograph your child?:    Y   N  (circle one)
May we have permission to use your child's photograph in church publications?:    Y   N  (circle one)
*T-Shirt Size:  __________________________________
Comments:
* Required