Child's First Name:  * Child's Last Name:  * Street Address:  * City:  * State:  * Zip Code:  * Parents/Guardians  * Home Phone:  * Work Phone:  * Cell Phone: Email Address: Grade in Fall of 2011: Birth date (mm/dd/yy):  * Emergency Contact (name and phone):  * Allergies or other concerns: Home Church: If you are bringing a friend and wish to be in the same multi-age crew please indicate friend's name here: Youth (older than 6th grade) and adults are welcomed to help for one or more days. Please indicate any interested helpers here: Security code:   * Do not enter anything in this field: