Lighthouse Church C3 Registration
Check all that apply:
Male
Female
First Name
*
Last Name
*
Address
*
City/State/Zip
*
Grade Level
*
T-Shirt Size
*
Birthdate
*
Age
*
Allergies/Medical Condtitions
Medical Conditions
Medications
Anything important we should know about your child?
Parent Information
Parent/Guardian Name
*
Address
*
City/State/Zip
*
Phone Number
*
Email
*
Relationship to child:
Who is allowed to pick up my child? Please specify his/her names:
Phone Number:
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