Child Check-In Registration

Mt. Tabor Child Check-In

Child's Information

First Name*

M.I.

Last Name*

Gender*

Male

Female

DOB*

Current Grade (if not of school age please type NA)*

Allergies/ Medicines (if none please type NA)*

Special Needs (if none please type NA)*

Parent's Information

Mother's First Name *

Mother's Last Name*

Phone*

Email address*

Street Address*

City*

State*

Zip Code*

Father's First Name*

Father's Last Name*

Email address

Phone*

Does the child live at this address

Yes