First Name
Last Name
Gender
Male
Female
Date of Birth
School Grade
-- None --
Nursery/Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Email Address
Phone Number
Parent/Guardian and relationship
Parent/Guardian and relationship
Mailing Address
Mailing City
Mailing State
Mailing Zip Code
ALLERGIES
PARENT/GUARDIAN NAME
WHO MAY PICK UP MY CHILD
ADULT LEADERS HAVE MY PERMISSION TO TRANSPORT MY CHILD TO/FROM EVENTS
Yes
No
I give permission for my child's photo to be used in Chadron Christian Church's social sites.
Yes
No
Choose Event
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Submit