Name: NEW NIGHT! Quarterly Conference
Start: 2025-01-15T18:00:00+00:00
End: 2025-01-15T18:00:00+00:00

Child's Name*

Parent/Guardian Name*

Email*

Phone: indicate home/cell*

Address*

Age*

Last Grade Completed*

FOOD ALLERGIES & MEDICAL INFORMATION*

Emergency Contact include name & phone number*

Dismissal Information include name & phone number*

Guest of

May we have permission to photograph your child?*

May we have permission to use your child`s photograph for the purpose of promotion?*

T-Shirt Size Youth/Adult(Y) XS,S,M,L or (A) S, M, L, Xl, XXl, etc.*

What is 4 + 5*

NEW NIGHT! Quarterly Conference

January 15 @ 6:00 pm