Parents Name *

First Name

Last Name

Parent Phone # *

(###)

###

####

2nd Parent Phone #

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does your child have a friend they wish to be in the same crew with?

Yes

No

I give my permission for my child(ren)'s picture(s) to be taken and used in church-related websites and social media *

Yes

No