• • Child's name *
    
    First
    
    Last
• • Child's birth date
    
    
• • Grade child completed spring 2013 *
    
    
• • 2nd Child (optional) You may skip this field if you are registering only one child.
    
    First
    
    Last
• • 2nd Child birth date
    
    This field is optional if you are only registering one child.
• • 2nd Child grade completed spring 2013
    
    This field is optional if you are only registering one child.
• • 3rd Child (optional) You may skip this field if you are not registering a third child.
    
    First
    
    Last
• • 3rd Child birth date
    
    You may skip this field if you are not registering a third child.
• • 3rd Child grade completed spring 2013
    
    You may skip this field if you are not registering a third child.

• • ---

• • Child(ren) address *
    
    Street Address
    
    Other Address (optional)
    
    City
    ...AlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory
    State/Province
    
    Zip/Postal Code
    
    Region (optional)
    ...United StatesCanadaJapanUnited KingdomAustraliaGermanyFranceSwitzerlandItalyNetherlandsAlbaniaAlgeriaAmerican SamoaAndorraAnguillaAntarticaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBouvet IslandBrazilBritish Indian Ocean Terr.Brunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslColombiaComorosCongoCook IslCosta RicaCote D'IvoireCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFaeroe IslandsFalkland Isl. (Malvinas)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Terr.GabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernsey C.I.GuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIsle of ManIsraelItalyJamaicaJapanJersey C.I.JordanKazakhstanKenyaKiribatiKorea Republic ofKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLiechtensteinLithuaniaLuxemborgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslMartiniqueMauritaniaMauritiusMexicoMicronesiaMoldova Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherland AntillesNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslNorthern Mariana IslNorwayOmanPakistanPalauPanamaPanama Canal ZonePapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts & NevisSaint LuciaSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSt. Vincent & GrenadinesSurinameSvalbard & Jan Mayen IslSwazilandSwedenSwitzerlandTaiwanTajikistanTanzania United RepublicThailandTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslTuvaluU.A.E.U.S.Minor Outlying IslUgandaUkraineUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican City StateVenezuelaViet NamVirgin Isl (British)Virgin Isl (U.S.)Wallis & Futuna IslandsWestern SaharaYemen Republic ofZaireZambiaZimbabwe
    Country
• • Child(ren) home phone number
    
    
    
    
    
    
• • Guardian 1 name *
    
    First
    
    Last
• • Guardian 1 relationship to child (mother, father, guardian, step-parent)
    
    
• • Guardian 1 email *
    
    This email will be used for primary communication for this event.
• • Guardian 1 home phone number
    
    
    
    
    
    
• • Guardian 1 cell phone number
    
    
    
    
    
    
• • Guardian 2 name
    
    First
    
    Last
• • Guardian 2 relationship to child (mother, father, guardian, step-parent)
    
    
• • Guardian 2 email
    
    
• • Guardian 2 home phone number
    
    
    
    
    
    
• • Guardian 2 cell phone number
    
    
    
    
    
    
• • Emergency contact name
    
    First
    
    Last
• • Emergency contact relationship to child
    
    
• • Emergency contact phone number
    
    
    
    
    
    
• • Special concerns/ALLERGIES/requests:
    
    

• • ---

• • Volunteer Section

    We rely on the enthusiastic support of volunteers! Could you serve in any of the following areas?
• • Check one or more areas you could help with:
    Daily check in
    Craft assistants
    Prop coordinators
    Drama assistants
    Dance assistants
    Costume coordinators
    Recreation assistants
    Lunch supervisors
    Prayer partners
    
• • Volunteer Name
    
    First
    
    Last
• • Volunteer phone number
    
    
    
    
    
    

Authentication Text*
(Enter the text in the image above into this field.)

NOTE: Do Not Alter These Fields: