Wacky Water Wednesday Registration

Parent/Guardian's Name (required)

Address

Home Number

Cell Number

Work Number

Email Address (required)

Child's Name (required)

Child's Gender (required)
MaleFemale

Child's Date of Birth (required)

Child's Last Grade Completed (required)
NurseryPreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade

Home Church Information

Medical Information (medications, allergies, etc.)

Emergency Contacts Other Than Listed Above

Who May Pick Up Your Child After Wacky Water Wednesday?

May we have permission to photograph your child during the week for promotions (GRBC Instagram, Twitter, Facebook)?
YesNo

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