Summer Spectacular 2010 Registration


For children entering Kindergarten – 5th Grade this Fall.
Please list only children living at the same address on this form:

Gender:
 boy girl
Age / Grade:*
Child\'s Name:*
Gender:
 boy girl
Age / Grade:
Child\'s Name:
Gender:
 boy girl
Age / Grade:
Child\'s Name:
Gender:
 boy girl
Age / Grade:
Child\'s Name:

Parents/Gaurdian:*

Address:

City:

State:

Zip:

Phone:*

E-Mail:*

Do you attend church?  yes no

Name of Church

How did you hear about Summer Spectacular?

If referred by someone, please enter their name:

Comments / Food Allergies