Returning Guest


Which Revive! Respite are you registering for?
Name, Age (First Last, Age)
Child's DOB
Sibling(s) attending respite (Please list name & age):
Please list any dietary restrictions your child has.
Are there any changes or updates since your last attended respite? (update/change to allergies, diet, contact info, etc.)
By selecting "Yes" on this form, I give permission for my child/children to attend and participate in the respite night. I understand and authorize that my child/children's image may be photographed or filmed and used in church related video presentations, printed publications, or church website/social media. I also give my consent and authorization for emergency transportation and any medical treatment my child/children may require in the unlikely event my child/children is injured or becomes ill while attending an event at Richland Creek Community Church.