Bible Street Meet Registration
Wednesdays, 6:30-8:00pm
Starting Sept 6th
@ Muntz's Home : 5516 Pinto St., Frederick, CO 80504
What is the Parent/Guardian full name for the child(ren) attending Street Meet? *

Street Meet often uses text for updates and reminders. What is your cell-phone number? *

{{answer_28443496}}, what is the name (first & last) of the child(ren) attending? *

Please give the date of birth for the child(ren):

Child(ren) must be 4th grade & 9 years old - 6th grade to participate.
Thank you! What grade is/are {{answer_28443527}}in this current school year? *

Child(ren) must be 4th grade & 9 years old - 6th grade to participate.
In case of emergency, who would you like us to contact? Please provide the full name, relationship to child, and contact number for this individual: *

Thank you, you're almost done! 

Medical Information: 
Is your child taking any daily prescribed medicines that we need to know about? Yes or no? *

If yes, please explain.
Is there any allergy information, or previous surgery's, accidents, chronic illneses, or special problems, that you would like us to be aware of?

Is there any additional information that you would like us to know that we didn't address? Your information will be kept confidential.

We appreciate the time you've given to fill out this form. We GREATLY look forward to the upcoming year. Welcome to Street Meet! Please click "continue" to finish the registration process...

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