SUMMER JAM Registration

2024 Student Registration

Term: May 29 CLASS 6:30-8:00 PM
Every Wednesday
Ages: 3yrs - 5th Grades

Child/Student

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Birthdate (MM/DD/YYYY): *

Age: *

Grade Just Completed: *

Gender: *

Male Female

Preferred Phone Number *

Preferred Email: *

First Time Visitor? *

Yes No

Church You Attend: *

MorningStar CC Other church We don't currently have a home church.

Church You Attend If Other: *

Allergies or Medical Conditions: *

A. Family Contact Information

Mother or Legal Guardian's Name: *

First

Last

Phone Number: *

Email: *

Father or Legal Guardian's Name: *

First

Last

Phone Number: *

Email: *

B. Emergency Contact Information (If Father or Mother Can't Be Reached)

Emergency Contact Name: *

First

Last

Emergency Contact Phone Number: *

Emergency Contact Relationship: *

EMERGENCY CONTACT #2* *

PHONE NUMBER *

Submit

Register for SUMMER JAM

2024 Student Registration

​Child/Student

A. Family Contact Information

B. Emergency Contact Information (If Father or Mother Can't Be Reached)

Child/Student