Please complete the following form:

Child's Name:
Address:
City:	Zip:
Age: (Must be 4 by 9/1/08) Last Grade Completed:
Parent Name:	(First & Last Name)
Cell Phone:	Home Phone:
Allergies or Medical Needs:
Any Other Special Situations:
Where Do You Regularly Attend Church?
Who Is Allowed To Pick Up Your Child?
Would You Like More Information About Cana And Its Childrens Ministry Sent To You? Select One Yes No