Child's Name (required)

Parent's Name (required)

Email (required)

Address (required)

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Alternate phone number

Child's Age (required)

Grade Completed (required)
—Please choose an option—N/AK51st2nd3rd4th5th6th

Child's Birthday (required)

Allergies/Medical Information
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Emergency Phone (required)

Home Church

Would You Like to Request Bus Transportation? (required)
YesNo