Thank you for filling out this registration form completely. This information will help us ensure the best possible experience for your child. Please enable JavaScript in your browser to complete this form.Your Child's InformationYour Child's Full Name *FirstLastNickname (if any)Sex *MaleFemaleDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade Level (as of Fall 2019) *Dates Your Child Will Attend Kids Fest8/038/108/178/24We hope your child will attend all four Saturdays of Kids Fest! To help us plan better, check the dates when your child attend.Allergies (including Food Allergies & Dietary Restrictions); Medical Concerns & Medications *Please list any dietary restrictions or allergies your child has, along with any medications your child must take during Kids Fest hours (11 a.m. to 3 p.m.). Also, for your child's safety, let us know if your child has a medical condition of which we should be aware.Home Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian InformationThe below-named individuals are authorized by you to pick up your child from Kids Fest. If someone not named on this form needs to pick up your child from Kids Fest, please call Beth Carver at (443) 345-6960 or Pastor Richard Reilly at (410) 596-5801 to let one of them know.Name of Parent or Guardian *FirstLastParent/Guardian Daytime Phone *Parent/Guardian EmailName of Parent or Guardian *FirstLastParent/Guardian Daytime Phone *Parent/Guardian EmailMay we contact you about future family events at Alesia, including Kids Fest?Yes, you may!No, thank you anyway.Special PermissionsPermission to Participate in Water Activities during Kids Fest *Yes, my child may participate in water activities. I understand that my child's clothing may get damp, wet, or soggy.NO, my child may not participate in activities where there's a chance he or she could get splashed or wet.Permission to Take Photos of Your Child *Yes, you may take pictures of my child at Kids Fest. I understand these images may be used on the church's website for promotional purposes.NO, you do NOT have my permission to take photographs of my child or use my child's likeness for promotional purposes.PhoneSubmit
