New Palestine Baptist Church

Student's Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

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Student Phone

(###)

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What activities are you interested in? *

Choose any that apply

Sports

Ropes Course

High-intensity games (dodgeball, four-square, tag)

Low-intensity games (strategy games, board games, trivia)

Water sports (canoeing, swimming)

Crafts/Art/Music

Other