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Participant Registration

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Registro en Español

Cross of Christ Ev. Lutheran Church & School

Location

9931 Foley Blvd.

Coon Rapids, MN 55433

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Contact Nicci Roper:

763-786-0637

nicciroper@crossofchrist.us

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Second Parent First Name

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Second Parent 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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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Alternate Pickup 2 Name

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Alternate Pickup 2 Phone

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Home Church Affiliation

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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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I give the staff and volunteers at Cross of Christ permission to help my child in case of an emergency.

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Authorization for Release of Photographs

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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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Comments

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