Lexington Baptist Church - Special Needs Ministry Respite Event - Saturday, March 21, 2020

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Lexington Baptist Church - Special Needs Ministry Respite Event - Saturday, March 21, 2020 - 10:00am-1:00pm

Please complete before arrival for the scheduled event. These questions are asked for the benefit of your child and so that we may provide the best experience and safest environment for everyone involved. Any information shared on this form is communicated directly with those caring for your child and only on a "need to know" basis.

Email *

Participant Full Name *

Date of Birth *

YYYY

Age *

Will any siblings be joining them? If so, include name, age and any special instructions or allergies.

Parent Name *

Cell Number *

Email Address *

Home Address

Other Persons Authorized to Pick Up Child

Emergency Contact (Full Name & Contact Number) *

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