JESUS
AND ME

for ages 3 (by Dec. 2021)

through Jr. Kindergarten

9:00 A.M. - NOON

AUGUST 2-4

Please submit one form per child.

Child's First Name

Child's Last Name

Child's Birthday

Please list all allergies or medical conditions

Parent 1 First Name

Parent 1 Phone

Parent 2 First Name

Parent 2 Phone

Parent 1 Last Name

Parent 1 Email

Parent 2 Last Name

Parent 2 Email

Street Address

State

City

Zip Code

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Alternate Pickup First Name

Alternate Pickup Last Name

Alternate Pickup Phone

If no, do you attend somewhere else?

Additional Information we need to know?

Thanks for registering your child for JAM 2022!

We have received your submission.