T & T Clubber Registration Form

Clubber Name*
Address*
City / State / Zip*
Date of Birth
Grade*
E-mail address
Current church home
Mother*
Mother phone number
Mother cell phone number
Father*
Father phone number*
Father cell phone number
Other Adult *
Other Adult phone number*
Other Adult cell phone number
Grandparents*
Grandparents phone number*
Grandparents cell 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


Submit


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