Child's Date of Birth *

MM

DD

YYYY

Parent/Carer 1 Name *

First Name

Last Name

Parent/Carer 2 Name

First Name

Last Name

Contact Number *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I understand the Thanksgiving process includes completing a short course on Christian belief with one of the staff *

Yes, I understand and will attend these meetings