Register me for Operation Space!
Child’s name ___________________________________________________________________________________________
Gender: Male Female Birthdate _______/_______/_______ Grade completed________
Address __ __________________________________
City _______________________ State _______ ___
Parents/Guardian________________________________________________
Home phone _____________________________
Work phone_________________________ _
Cell phone___________________________
Email _________________________
Emergency contact _____________________________________________________________________________________
Relationship to child _________________________________________________
Phone _____________________________
____________________________________________________
Name of home church __________________________________________________________________________________
Food allergies Y___ N___
List_____________________________________________________________________________
Medical concerns Y___ N___
Explain_______________________________________________________________________
