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How did you hear about KidsGames?: *


 
Parent's First Name: *

 
Parent's Last Name: *

 
Address: *

 
City: *

 
Zip Code: *

 
Best Phone #: *

 
Emergency Contact Name  (First & Last): *

Please list another adult who we would contact if we are unable to reach you in the event of an emergency.
 
Emergency Phone #: *

 
Child's First Name: *

 
{{answer_46722997}}'s Last Name: *

 
How old will {{answer_46722997}} be during KidsGames?: *

 
{{answer_46722997}}'s gender: *


 
{{answer_46722997}}'s Birthdate: *

 
What grade / class will {{answer_46722997}} be entering in Fall 2017?: *


 
What is {{answer_46722997}}'s t-shirt size?: *


 
If needed, which children's medication(s) is the Nurse able to administer?:

NOTE: if the nurse gives any approve medication a parent will be notified.

 
Does {{answer_46722997}} have any allergies?: *

     
 
Please list {{answer_46722997}}'s allergies: *

 
Does {{answer_46722997}} have and/or know how to self-administer an EpiPen?: *


 
Does {{answer_46722997}} have any Medical Concerns?: *

     
 
Please list {{answer_46722997}}'s medical concerns and anything we need to be aware of: *

 
Does {{answer_46722997}} have any Special Needs?: *

*special needs such as autism, down syndrome, physical, mental or emotional needs, social anxiety etc.
     
 
Please list {{answer_46722997}}'s special needs and anything we need to be aware of: *

 
Do you feel {{answer_46722997}} will need a buddy during KidsGames?: *

A buddy will be assigned to your child if you feel your child needs one on one care / attention during KidsGames.
     
 
What is {{answer_46722997}}'s Medical Insurance Company?: *

 
{{answer_46722997}}'s Group / Policy Number: *

 
Which week(s) of KidsGames would {{answer_46722997}} like to attend?: *


 
Does {{answer_46722997}} want to be with another child or leader? *

     
 
Who does {{answer_46722997}} want to be with?: *

Request must be mutual (2 requests maximum)
1st-6th graders friend request must be same gender and in the same elective
OTHERWISE REQUEST CANNOT BE HONORED
 
Which option best describes {{answer_46722997}}?: *


 
What church does {{answer_46722997}} attend?: *

 
Select 'I accept' to indicate you have read and agree to NCCC's Parent Permission document which you can find by clicking the link below: *

 
Week 1 Elective Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 1 Backup Elective [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 2 Elective Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 2 Backup Elective [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 3 Elective Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 3 Backup Elective [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 4 Elective Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 4 Backup Elective [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 1 Electives Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 1 Backup Electives [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 2 Electives Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 2 Backup Electives [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 3 Electives Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 3 Backup Electives [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 4 Electives Choice [boys]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 4 Backup Electives [boys]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 1 Elective Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 1 Backup Elective [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 2 Elective Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 2 Backup Elective [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 3 Elective Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 3 Backup Elective [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 4 Elective Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 4 Backup Elective [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 1 Electives Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 1 Backup Electives [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 2 Electives Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 2 Backup Electives [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 3 Electives Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 3 Backup Electives [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Week 4 Electives Choice [girls]: *

Make sure to find out {{answer_46722997}}'s first choice because this can NOT be changed later

 
Week 4 Backup Electives [girls]: *

This will only be used if {{answer_46722997}}'s first choice is not available. This can NOT be changed later.

 
Would you like to sponsor a child with a KidsGames scholarship?: *

NOTE: $100 needed to provide a full scholarship
For more donation options check out our separate scholarship donation form:
https://wholelifesports.typeform.com/to/OfddZk

 
Your KidsGame total is {{var_price}} *

 
Please enter your Credit or Debit Card number: *

 
The CVC number: *

(3 or 4 digit security number on the back of your card)
 
The name on your card: *

 
Your card's expiry month: *


 
Your card's expiry year: *


Thanks for signing {{answer_46722997}} up for KidsGames 2017!
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