Summer Adventure Week 2011 "SonSurf Beach Bash" Sunday, June 26 - Thursday, June 30 6:15 pm - 8:30 pm Community Carnival Saturday, July 23, 2011 from 4-8 pm Registration is for all kids Ages 4 - Grade 6 (NOTE: A separate registration form is needed for each child.)
Child's First Name:
Child's Last Name:
Date of Birth:
Grade Entering:	Pre-K (Age 4) K 1 2 3 4 5 6
Allergies or Other Concerns:
Parent / Guardian:
Address 1:
Address 2:
City, State, Zip:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Phone Number:
Others Permitted to Pick Up Your Child:
Do you regularly attend a church most Sundays?	Yes No
If so, what is the name of your church?