Summer-Registration3

Summer Kids' Week Registration

Dinner will be served each night. If your child(ren) has any food allergies, please let us know on this form.

* Indicates required field

Parent/Guardian Name *

First

Last

Parent/Guardian BEST Phone Number *

Parent/Guardian Email *

Parent/Guardian Mailing Address *

Emergency Contact Name *

First

Last

Emergency Contact Relationship to Child(ren) *

Emergency Contact BEST Phone Number *

Child 1 Name *

First

Last

Child 1 Birthday *

Child 1 Grade Just Completed *

Child 1 Allergies or Medical Conditions *

Child 2 Name *

First

Last

Child 2 Birthday *

Child 2 Grade Just Completed *

Child 2 Allergies or Medical Conditions *

Child 3 Name *

First

Last

Child 3 Birthday *

Child 3 Grade Just Completed *

Child 3 Allergies or Medical Conditions *

Child 4 Name *

First

Last

Child 4 Birthday *

Child 4 Grade Just Completed *

Child 4 Allergies or Medical Conditions *

Submit

New Life Presbyterian Church
3500 Fulwood Road
Tifton, GA 31794

229.382.7238
[email protected]