Kid's Revival 2017 Friday, August 4, 2017 7:00 PM 19:00 Saturday, August 5, 2017 8:30 PM 20:30 GPC Benton 402 Edison Avenue Benton, AR, 72015 United States (map) Google Calendar ICS Have a blast with us as we experience Kid's Revival 2017! REGISTER ONLINE Parent/Guardian Name * First Name Last Name Will you be staying for the duration of Kid's Revival 2017? * Yes No Email Address * Phone * (###) ### #### Emergency Phone * (###) ### #### Is this your first time to our church? Yes No CHILD'S INFORMATION 1st Child's Name * First Name Last Name Age * -- 4 5 6 7 8 9 10 11 Grade * -- Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade Allergies/Medical Conditions 2nd Child's Name First Name Last Name Age -- 4 5 6 7 8 9 10 11 Grade -- Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade Allergies/Medical Conditions 3rd Child's Name First Name Last Name Age -- 4 5 6 7 8 9 10 11 Grade -- Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade Allergies/Medical Conditions Thank you! We look forward to seeing you at Kid's Revival 2017!
