Name: _____________________________________________
Parents or Guardians:________________________________________________
Address: _________________________________________________________________
City: __________________________State: _________ Zip: _________
Home Telephone: __________Work Phone____________ Cell Phone______________
E-mail address: _________________________________________________________
Age: _____ Year and Date of Birth: _________ Current (2012-2013) grade: ________
In case of emergency contact: ________________________________________________
Allergies or other medical conditions: ________________________________________
Home Church: _______________________________________________
$5.00 registration fee: ______________paid
_________Please waive this fee.
Other information we may need to know:______________________________________
T-shirt size (circle one) Child 6-8 Child 10-12 Child 14-16
adult small adult medium
adult large adult XL
____________________________________________________________________________
Please return form to St. Mark UMC, 550 Highway 72 Bypass NW, Greenwood, SC 29649
or email to [email protected]
Form MUST be received by May 13, 2013 in order to receive a shirt.
For church use only: Kingdom CREW: