Starting Wednesday, September 6th @ 6:30 - 8 PM
LIFE Fellowship of Frederick
451 Oak St. Frederick, CO 80530
What are the first and last name(s) of the child(res) participating from your family? *

(Please indicate whether the child is a boy or a girl by placing a (B) or a (G) after each name)
Please list the birthdates of each participating child in the same order as above.

Child(ren) must be in Kindergarten & 5 years old - 3rd grade to participate.
What are the grade levels of the above listed child(ren)? *

Child(ren) must be in Kindergarten & 5 years old - 3rd grade to participate.
What are the names of the Parents / Guardians of the participating children?

What is the best number to reach you in case of emergency or last-minute change of plans (think bad weather)?

Do any of the participating children have food allergies? If so, please list the first name of the child and the allergen(s).

Last question! Is there anything we have not asked yet that you think we should know about a participant?

(Your answers will remain confidential)
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