Parent's First Names
Parent's Last Name
Address
City	State Zip
Home Phone	( ) -
Work Phone	( ) -
Email
Emergency Contact Name:
Emergency Contact Phone:
I give permission to use photos of my child: Yes No
Child 1: First Name Last Name Birth Date Grade in Fall Gender M F Allergies or other needs
Child 2: First Name Last Name Birth Date Grade in Fall Sex M F Allergies or other needs
Child 3: First Name Last Name Birth Date Grade in Fall Sex M F Allergies or other needs
Child 4: First Name Last Name Birth Date Grade in Fall Sex M F Allergies or other needs
A $50/kid donation is suggested. Registration: * $ = $ Additional Donation: $ Total: $
Payment Method Mogiv/Credit Card Mail Check Request Scholarship