Registration Form *Child's First Name: *Child's Last Name: *Address: *City: *State: *Zip: Home Phone: (555-555-5555) Cell Phone: (555-555-5555) Your email address: Gender: Male Female Child’s Birthday: (12/31/2006) Last Grade Completed: Not in school yet Pre-kindergarden Kindergarden First Grade Second Grade Third Grade Fourth Grade Fifth Grade (Allergies, Medical, & Special Needs): Emergency Contact Information: Name: Phone Number: Dismissal Information:    Who may pick up your child? Authorized Pickup Name #1: Authorized Pickup Name #2: Other Information: Are you a member of this church?   Yes No     If you are visiting our church, who are you a guest of? Do you attend church? Yes No    If so where? May we have permission to photograph/video your child?    Yes No May we have permission to use your child's photograph/video in church publications?    Yes No T-Shirt Size: Extra Small Small Medium Large Extra Large Other Class: Puggles (Coed 2 yrs. old) Cubbies (Coed 3 - 5 yrs. old) Sparks (Coed K - 2nd Grade) T & T Boys (3rd - 5th Grade) T & T Girls (3rd - 5th Grade) Comments/Questions: