HWC Treasured Registration Form 2022
July 24th-28th @ 6-8:30pm.
Child #1
Child's Name
First Name
Last Name
Child's date of birth
-
Month
-
Day
Year
Date
Child's Gender:
Please Select
Male
Female
Prefer Not to Answer
Last school grade completed:
Please Select
Preschool-3 years old (must be potty trained)
Preschool-4 years old
Preschool-5 years old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Child #2
Child's Name
First Name
Last Name
Child's date of birth
-
Month
-
Day
Year
10/13/2011
Child's Gender:
Please Select
Male
Female
Prefer Not to Answer
Last School grade completed:
Please Select
Preschool-3 years old (must be potty trained)
Preschool-4 years old
Preschool-5 years old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Child #3
Child's Name:
First Name
Last Name
Child's date of birth
-
Month
-
Day
Year
Date
Child's Gender:
Please Select
Male
Female
Prefer Not to Answer
Last school grade completed:
Please Select
Preschool-3 years old (must be potty trained)
Preschool-4 years old
Preschool-5 years old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Child #4
Child's Name:
First Name
Last Name
Child's date of birth
-
Month
-
Day
Year
Date
Child's Gender:
Please Select
Male
Female
Prefer Not to Answer
Last school grade completed:
Please Select
Preschool-3 years old (must be potty trained)
Preschool-4 years old
Preschool-5 years old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Contact Information
Name of parent/caregiver #1 :
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Name of parent/caregiver #2:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email address:
example@example.com
Home Church (if applicable)
Medical Information
Allergies, Medical conditions, or special needs:
Emergency contact:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Relationship to Child:
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: