Eggstravaganza Family Registration

Please complete the entire form and then click submit.
Your child(ren) are not registered until you click submit.


Parent/Guardian First
Name (*)
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Parent/Guardian Last
Name (*)
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Street Address (*)
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City (*)
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State
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Zip Code (*)
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Phone (*)
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E-mail Address (*)
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How did you hear
about
EGGstravaganza?
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You have the ability to register up to 5 children at one time.
Please complete all information for each child.



First Child

Child's First Name (*)
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Child's Last Name (*)
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Child's Birthday
(mm/dd/yyyy) (*)
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Grade (*)
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Gender (*)
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Can this child's photo be used at Riva Trace Baptist Church for promotion? (*)
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Can this child's photo be used in public publications for promotion (newspapers', etc.)? (*)
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Second Child

Child's First Name
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Child's Last Name
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Child's Birthday
(mm/dd/yyyy)
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Grade
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Gender
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Can this child's photo be used at Riva Trace Baptist Church for promotion?
Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?
Invalid Input



Third Child

Child's First Name
Invalid Input
Child's Last Name
Invalid Input
Child's Birthday
(mm/dd/yyyy)
Invalid Input
Grade
Invalid Input
Gender
Invalid Input
Can this child's photo be used at Riva Trace Baptist Church for promotion?
Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?
Invalid Input



Fourth Child

Child's First Name
Invalid Input
Child's Last Name
Invalid Input
Child's Birthday
(mm/dd/yyyy)
Invalid Input
Grade
Invalid Input
Gender
Invalid Input
Can this child's photo be used at Riva Trace Baptist Church for promotion?
Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?
Invalid Input



Fifth Child

Child's First Name
Invalid Input
Child's Last Name
Invalid Input
Child's Birthday
(mm/dd/yyyy)
Invalid Input
Grade
Invalid Input
Gender
Invalid Input
Can this child's photo be used at Riva Trace Baptist Church for promotion?
Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?
Invalid Input



BY SUBMITTING THIS REGISTRATION I understand that childcare/supervision will not be provided and I will be responsible for supervising my children. I assume the risk of our participation and hold harmless Riva Trace Baptist Church, its employees, agents and volunteers, from and against any claims or damages, of personal injury, property damage or otherwise.