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Participant Registration

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Registro en Español

Abundant Life Community Church

Location

7333 Sharon Rd.

Newburgh, IN 47630

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Contact Kim Forston:

812-853-3437

kforston@alccn.org

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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You will be the primary contact in the case of any issues or emergencies. Please give us a good contact phone number below.

Contact Phone 1

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In the event that we cannot reach you, please give us an emergency contact person [SOMEONE OTHER THAN YOURSELF] and their phone number. We recommend a parent (not listed above), grandparent, or close family friend.

Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Will your child/children be dropped off or picked up by someone else? Please list below:

Alternate Pickup Name

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Home Church

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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T-shirts will be available for purchase. What size would your child need?

Shirt Size

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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Comments

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