Participation Form
Student Name
Street Address
City
Zip
Home Telephone
Cell Phone
Your Email Address
*
Birthday
T-Shirt Size (Small, Medium, Large, XL)
School
Grade
Mom's Name
Mom's Cell Phone
Mom's Email Address
Dad's Name
Dad's Cell Phone
Dad's Email Address
Emergency Contact
Emergency Contact's Cell Phone
Allergies/Other info such as food restricitons
I authorize my child to use transportation that has been arranged by MLC
*
No
Yes
I authorize MLC to use photographs of my child for publication s (such as flyers, newsletters, websites, etc.)
*
No
Yes
Online Giving
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