Jr Disciple Registration Jr Disciple Registration Child's Name* First Last Age* Parent's Name* First Last Phone*Email Address* AllergiesList any allergies your child has Photo Release*From time to time during Jr Disciples we will be taking pictures. These pictures could potentially be used on our website and/or our Facebook page. Do we have permission to use your child's picture? Yes No Parent's Signature*Please enter your full name Date* Month Day Year Δ
