Child's Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Photo Release *

I give Covenant Church Permission to take photos of my child during the week and use for promotional purposes.

Yes

No

Parent or Guardian 1 *

First Name

Last Name

Parent Guardian 1 Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Guardian 2

First Name

Last Name

Parent Guardian 2 Phone Number

(###)

###

####