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August 2-6, 2010
7-9 PM Nightly

(age 3yrs. - 5th grade)

 

Come join us in the wild west as we teach these children they are wanted by God.


** Please fill in one form per child, after you submit each form you will be taken to a new form.
  Child's Information:
Child's First Name:
Child's Last Name:
Date of Birth: mm/dd/yyyy
Child's Gender:
M F
Child's Age:
Parent/Guardian Information:
Parent/Guardian First Name:
Parent/Guardian Last Name:
Address:
City:
State:
Zip/Postal Code:
Home Phone:
Alternate Phone:
Email Address:
Confirm Email Address:
General Information:
Emergency Contact:
Relationship to Child:
Emergency Phone:
Allergies/Medical Needs:
My Child May Be Picked Up By:
  
First and Last Name:
First and Last Name:
Do you attend a church regularly?
 Y N
If yes, which church?