Name *

First Name

Last Name

Gender *

Male

Female

Wheelchair/Accessibility Device Dependent *

Yes

No

Special Communication Needs *

Yes

No

Sensory Issues/Concerns *

Yes

No

Allergies *

Yes

No

Food Needs *

Please select all that apply. Select "Other" for additional food needs. If you have no food needs, please select "None".

None

Dairy Free

Gluten Free

Soy Free

Sugar Free

Vegan

Vegetarian

Mechanical Soft

Other

Will guest need medication administered during the event? *

Please note Calvary Chapel Eastside staff and volunteers are not responsible for administering medication to guests during the Summer Sizzle event. If medication is required during the event, a parent or caretaker MUST be available to administer the medication.

Yes

No

Parent/Caretaker Name *

First Name

Last Name

Parent/Caretaker Phone *

(###)

###

####

Parent/Caretaker Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Parent/Caretaker Name

First Name

Last Name

Additional Parent/Caretaker Phone

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####