Kids Explosion Registration

Eastwood Kids Explosion form

We look forward to an exciting time this year teaching and loving on each child. We will learn all about being Created by God and that we are each built for a special purpose.

Child's name (First & Last Name):*
Child's date of birth:*
Child's Gender
Child's age:*
Grade*
Street Address*
City
State
Zip Code
Parent(s) name:*
Parent(s) phone number (in case of emergency):
Person responsible for this child (besides parent, if necessary):
Person responsible phone number:
Church the child regularly attends:
Please list any health concerns or allergies we should be aware of: