Registracion del Participante

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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

Primero, cuéntenos sobre usted:

Información de los Padres

Registration

Nombre

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Apellido

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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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País

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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Mensaje de texto Teléfono

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

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Nombre del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Cuéntanos sobre tu participante

Nombre

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Apellido

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

Grado Saliendo

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Género

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Fecha de nacimiento

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Age

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Alergias

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Preocupaciones Médicas

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Comentarios

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