Participant Registration

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Yates Thagard Baptist Church

Location

3820 Vass Carthage Rd.

Carthage, NC 28327

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Contact CW Matthews:

910-949-3511

cw@yatesthagard.com

First, Tell Us About Yourself:

Parent Information

Registration

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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Country

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Contact Phone 1

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Contact Phone 2

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Text Message Phone

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Cell Phone Carrier (Verizon,AT&T,Cricket,etc.)

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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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Tell Us About Your Participant

First Name

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Last Name

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*Note: When selecting "Grade Leaving" the Pre-K option is for 3 and 4 Year olds only

Grade Leaving

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Gender

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Date Of Birth

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Age

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Allergies

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Medical Concerns

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Comments

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