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Summer Lunch Program- June 3rd to June 6th (11:30 - 12:00 PM) Location: First Presbyterian Church 600 W. Temple, Effingham, IL
Participant Registration Form (One Per Child)
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Child's Name
*
Your answer
Child's Age
*
Your answer
Grade Entering
*
Prek
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Name of Parent(s)
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number 1
*
Your answer
Phone Number 2
*
Your answer
Email Address
*
Your answer
Allergies or other Medical Conditions
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Emergency Contact- Relationship to Child
*
Your answer
Please mark the days that you will be joining us for lunch, or taking a lunch with you.
Monday (11:30 - 12 pm Lunch)
Tuesday (11:30 - 12 pm Lunch)
Wednesday (11:30 - 12 pm Lunch)
Thursday (11:30 - 12 pm Lunch)
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