Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Parent or Guardian Name *

First Name

Last Name

Phone *

(###)

###

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Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

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Do you consent to having your child photographed for church social media and presentation purposes? *

Yes

No