Una Baptist Church
Monday, August 20, 2018
 
 
 
   Online Registration
 
 
 
 
 
 
Child's First Name:  
Child's Last Name:   
 
Child's Date Of Birth (mm/dd/year):  
 
Gender:      Male        or        Female
 
Child's Address:
 
Parent's First Name:  
Parent's Last Name:  
Parent's Address (if different):       
 
Parent's Cell Phone with area code:  
Parent's Email Address:  
 
If not the parent, who will be providing Transportation
First Name:  
Last Name:   
Adult's Cell Phone with area code:   
 
 
Please identify child's Allergies or health concerns:
 
 
 
What T-shirt size do you want for your child?
   Adult size
   Child size

   Extra small
   Small
   Medium
   Large
   Extra Large
 
Child's Age or Grade in School in Fall 2018*:  
      3 year-old
      4 year-old
      5 year-old
      1st Grade
      2nd Grade
      3rd Grade
      4th Grade
      5th Grade
      6th Grade
 

School:  

 

Do we have permission to use a photograph of your child? (example: for use in our church or on our Website)

      Yes
      No
 

Please name any instruments your child can play:  

 
 
Please press this button: