You may download the registration form (in PDF format) and complete and print it with the free Adobe Acrobat Reader or supply the information requested below:

WEDNESDAY NIGHT ALIVE!
REGISTRATION FORM

Street: _________________________________________________________

City, State, Zip: __________________________________________________

Home Phone: ___________________________________________________

Parent's E-mail: _________________________________________________

Are all health and contact info same as in Fall 2003? Yes No (please circle one)

We will communicate with you by e-mail unless you indicate otherwise:

_____________________________________________________________

Child’s Grade in School Fall 2004: __________________________________

Childs’ Birth Date: _______________________________________________

Paid $25 registration Fee? Yes No (please circle one)

ACTIVITIES
(CHECK ALL THAT APPLY)