Sparks All About Me Child Registration Form

Clubber's Name*
Address*
City / State / Zip*
Date of Birth*
Grade*
Current Church Home
Email Address*
I come to SPARKS Club with
Mother and Emergency Phone Number
Father and Emergency Phone Number
Other Emergency Contact Person and Phone Number
Other Emergency Contact and Phone Number
We have snacks and water (soft drinks on special occasions)
Any Food Allergies? *
 Yes
 No
If yes, please list any food allergies
Any physical conditions your child may have that we need to be aware of?*
 Yes
 No
If yes, please list below
We have game time and we run and play. Are there any physical concerns we need to know about your child?*
 Yes
 No
If yes, please list below
Other Special Circumstances


Submit


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