Summer Blast Registration 2017
 
Summer Blast Registration 2017
Do You Attend NorthStar Church?  * 
Which campus will your child/children be attending?  * 
Name of Child 1:  * 
Birthdate of Child 1:  * 
Age of Child 1 as of September 1st 2016:
(Must Be 3 Years Old or More)
 * 
Grade Completed of Child 1:
The grade he/she just completed
 * 
What special needs, allergies, or other concerns do we need to be aware of for Child 1?
Name of Child 2:
Birthdate of Child 2:
Age of Child 2 as of September 1st 2016:
(Must Be 3 Years Old or More)
Grade Completed of Child 2:
What special needs, allergies, or other concerns do we need to be aware of for Child 2?
Name of Child 3:
Birthdate of Child 3:
Age of Child 3 as of September 1st 2016:
(Must Be 3 Years Old or More)
Grade Completed of Child 3:
What special needs, allergies, or other concerns do we need to be aware of for Child 3?
Name of Child 4:
Birthdate of Child 4:
Age of Child 4 as of September 1st 2016:
(Must Be 3 Years Old or More)
Grade Completed of Child 4:
What special needs, allergies, or other concerns do we need to be aware of for Child 4?
Name of Child 5:
Birthdate of Child 5:
Age of Child 5 as of September 1st 2016:
(Must Be 3 Years Old or More)
Grade Completed of Child 5:
What special needs, allergies, or other concerns do we need to be aware of for Child 5?
Parent/Guardian Name:  * 
Street Address:  * 
City:  * 
State:  * 
ZIP:  * 
Parent Phone Number:  * 
Emergency Contact and Phone Number:  * 
Your Email Address  * 
 
 
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