Child's Name:

Date of Birth:

Age:

Last Grade Completed:

T-shirt Size: Child YXS (2-4) Child YS (6-8) Child YM (10-12) Child YL (14-16) Child YXL (18-20) Adult S Adult M Adult L Adult XL Adult 2X

Home Address:

City:

State:

Zip code:

Parent's Name:

Home Phone:

Cell Phone:

Emergency Contact Name:

Emergency Contact Phone #:

If space permits, please list any family members or friends you would like to be grouped with:

Is your child allergic to anything? No Yes

If yes, please provide allergy information:

Does your child have any special needs? No Yes

If yes, please provide special instructions:

Who will be picking up your child?

Do you currently attend church? No Yes

If yes, where?