Christian Temple Youth Registration Form
Please fill this form out for every child participating in Wednesday Night Youth individually 
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Child's Name *
Child's Age *
What grade is the child in? *
Address  *
Does your child have any allergies? If yes, please list.  *
Parent's Name and phone number *
Emergency Contact's name and phone number *
Does your child need to be picked up by the van? *
Where does your child need to be picked up from?
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What address does the bus need to pick your child up at?
Does your child need to be taken home by van? *
What address do we need to drop you child off at?
Is your child allowed to walk home? *
Is there any adult that you authorize to pick up your child other than yourself? *
Who do you give permission to pick up your child? 
I give permission for my child to be photographed and videotaped during church activities. My child’s image may appear in print or online promoting the church’s activities, including the church’s website, promotional brochures, worship presentations and the Christian Temple’s Facebook page. 
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