11/17/19 – Skipping Thanksgiving – 1 Thess 5:18

Child's Information:*

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Date of Birth:*

Grade:*

Hobbies/Activities:

Church Home:

Brought by:

Invited by:

Siblings:

List any allergies or medical conditions:

Parent's Name*

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Address*

Street Address Address Line 2 City State ZIP Code

Parent's Cellphone:*

Parent's Other Phone:

Parent's Email:*

Will someone besides you be picking up your child?*

Who will be picking up your child?*

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Pickup Person's Phone*

Emergency Contact Information: (Other than parent)*

First Last

Emergency Contact Phone*