SEVERAL AREA CHURCHES

Date & Time: October 17th at 6:00PM

Parent/Guardian Full Name *

Phone *

Email *

Please provide the full names of all the children you will be registering *

Please provide the ages and grades of all the children you will be registering *

Special Needs/Allergies (If Applicable)

Emergency Contact Name & Phone *

NORTH LOCATION: 915 E 53rd St N - Park City, KS 67219

SOUTH LOCATION: 2020 E Blake St - Wichita, KS 67211

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PHONE: (316) 838-9200