Drop & Shop Registration

Please complete a separate form for each child, thank you!

Parent's Name *
Parent's Name
Phone Number *
Phone Number
This number will only be used in the event we need to contact you about your child during the event.
Additional Phone Number
Additional Phone Number
Child Information
Please complete a separate form for each child.
Child's Name *
Child's Name
Child's Birth Date *
Child's Birth Date
Please list any food allergies or specific dietary needs. Menu//French Toast Sticks, Sausage, Applesauce, Fruit and Rice Krispy Bars
Please explain any important medical or behavioral information our staff should know about while caring for your child.
Other Information
Do you attend Peace Church? *
Do you attend a different church? *
Would you like to learn more about Peace Church and have a staff member contact you? *