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Registracion del Participante

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Trinity On Jackson (Elkhart)

Location

2715 E Jackson Blvd

Elkhart, IN 46516

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Contact Lori Grasty:

574-294-7602

lori@trinityonjackson.org

Primero, cuéntenos sobre usted:

Información de los Padres

Nombre

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Apellido

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Phone Number

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Correo Electrónico

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Dirección 1

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Dirección 2

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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Nombre del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Additional Contact Information (please provide name & phone number of 1 additional person)

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Additional Contact Phone Number

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Afiliación de la iglesia local

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Cuéntanos sobre tu participante

Which session will they be attending?

Nombre

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Apellido

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Género

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Fecha de nacimiento

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Grado Entrando

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If Preschool, what age is your child? (all children must be potty-trained)

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Talla de Camisa

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Allergies: Does your child have any food allergies? (if yes, we ask that you supply a snack each day for your child. At this time we do not have the ability to accommodate food allergies during our brief snack time).

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Does your child have any special needs or medical concerns?

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If your child has any special needs or medical concerns, please explain ...

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Please note: we try our best to accommodate requests to be with friends; however, children MUST be in the same age/grade to be together. Please trust group arrangements that are made - we work hard to ensure EVERYONE has a positive experience. If your child is having a hard time, please let one of our directors know so we can address the situation.

Does your child have anyone you would like to be placed with? (All groups are based on AGE/GRADE so not all requests can be accommodated).

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Scholarships are available if you are unable to afford the full cost of registration. All children are invited to attend! Are you in need of a scholarship to help with the cost of registration?

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