WNL! Registration

Fields marked with an * are required

Parent/Guardian #1 Name (First & Last) *

Email *

Phone *

Parent/Guardian #2 Name (First & Last)

Phone

Address *

City *

State *

Zip *

Other Emergency Contact Name (First & Last)

Other Emergency Contact Phone Number

Others allowed to pickup your child (First & Last names)

Preferred method of contact *

Church you attend (not required)

Child #1 Name (First & Last) *

Grade *

Birthdate *

Child #2 Name (First & Last)

Grade

Birthdate

Child #3 Name (First & Last)

Grade

Birthdate

Child #4 Name (First & Last)

Grade

Birthdate

Invited by

Allergies and or Special instructions

Medical Release *

In lieu of your signature, please enter your initials: *

Allow church use of photographs and or videos of above minors *