Form
Special Needs Easter Egg Hunt
April 9, 2022 10:00 am - 1:00 pm
Parent or Guardian's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What is the name and age of the individual participating in the egg hunt?
*
What is your child's diagnosis?
*
Does your child use any of the following items:
Walker
Wheelchair
Crutches
Braces
None of the above
Other
Please provide any other information that may help us in preparing for this event. If you chose other for the previous question, please explain below.
Please list any siblings and their age that will be participating in the egg hunt.
PHOTE RELEASE: I give permission to use pictures of my child(ren) in publications, newsletters, social media, and website of Genes of Joy and Pine Summit Baptist Church. (if NO please sign NO in box below)
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