Name of Parent or Guardian *

First Name

Last Name

Phone # of Parent or Guardian *

Please list a phone number so that we may contact you.

(###)

###

####

Emergency Contact *

Please list a person we can call in the case of an emergency, if we are unable to reach you.

First Name

Last Name

List Phone Number for Emergency Contact *

(###)

###

####

First Child's Name

Please the name of the first child you are registering.

First Name

Last Name

Date of Birth for First Child *

Only children who fall within the ages of 4-12 years old will be able to attend.

MM

DD

YYYY

Second Child's Name

Please the name of the second child you are registering.

First Name

Last Name

Date of Birth for Second Child *

Only children who fall within the ages of 4-12 years old will be able to attend.

MM

DD

YYYY

Third Child's Name

Please the name of the second child you are registering.

First Name

Last Name

Date of Birth for Third Child *

Only children who fall within the ages of 4-12 years old will be able to attend.

MM

DD

YYYY

"I understand that I am responsible for signing in my child(ren) each day of the event *

Yes

No

I acknowledge that all individuals facilitating these events are serving in a voluntary capacity. I agree not to hold any volunteer liable for any reason arising from their participation in these events.

Yes

No

"I acknowledge and grant permission for photographs of my child(ren) to be taken and used by Highland Community Church on its social media platforms

Yes

No