NKCC

Mother

Father

Mother's Religion

Father's Religion

Address

City

Zip Code

E-Mail (if preferred method of contact)

Phone

Other Phone

Child's Name

Child's Gender 1 : : Please select... Please select...  1 : : Male Male  1 : : Female Femail 

Birthdate

Grade

Child's Name

Child's Gender 1 : : Please select... Please select...  1 : : Male Male  1 : : Female Femail 

Birthdate

Grade

Other Children Name - Gender - Birthdate - Grade

Other Household Members

Any special needs?  * 1 : : Please select... Please select...  1 : : Yes Yes  1 : : No No 

Please describe special needs

Any food allergies  * 1 : : Please select... Please select...  1 : : Yes Yes  1 : : No No 

Please describe food allergies

Volunteer Opportunities 1 : : Please select... Please select...  1 : : Activity Planning Activity Planning  1 : : Activity Leadership Activity Leadership  1 : : Small group facilitator Small group facilitator  1 : : Service projects Service projects  1 : : Home kit preparation Home kit preparaton  1 : : Setup Setup  1 : : Meal Planning Meal Planning  1 : : Check-in/Welcoming Check-in/Welcoming  1 : : Behind the scenes (phone calls, publicity, etc.) Behind the scenes (phone calls, publicity, etc.)  1 : : Cleanup Cleanup  1 : : Meal Serving Meal Serving 

Other Volunteer Opportunities

   

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