* Date

* Child Name

* Parent's Name

* Address Line 1

Address Line 2

* City, State Zip

* Home Phone

Cell Phone 1

Cell Phone 2

* Email

* Where can parents be reached during EZX in case of emergency

* Alternate Emergency Contact

* Relationship to Child

* Alternate Emergency Contact Phone

Medical Concerns

Food Allergies

* Child's Current Age

* Birthdate

* Grade in School

* School Name

Child's Favorite Bible story or character

Child's Special Interents or Hobbies

Usual Church Attended (if not TSCC)

Attending with

Other Information

* Verify