Cubbies All About Me Child Registration Form

Your Child's Name*
City / State / Zip*
Parent(s) phone number*
Parent(s) cell phone number
Grandparent(s) phone number*
Grandparent(s) cell phone number
Other Adult With Permission To Pick Up Child*
Other Adult phone number*
Other Adult cell phone number
Date of Birth*
My church home is
We have snacks and water (soft drinks on special occasions)
Any Food Allergies? *
If yes, please list any food allergies
Any physical conditions your child may have that we need to be aware of?*
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?*
If yes, please list below


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