Puddle Splashers Registration • Overflow Church

In order for us to care and serve your child to our greatest capacity, please fill out the information below.

Please Fill Out Child's and Parent's Information:

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Child's Gender *

Child's Allergies: *

Tip: Please list all allergies

Additional Info: *

Tip: Does your child have any special needs we need to be aware of?

Parent Name (Parent or Guardian Registering/Dropping Off/Picking Up) *

Parent's Phone Number *

Parent's Email Address *

Home Address *

Home City *

Home Zip Code *

Do you give us permission to use your child's photo on social media? *

Tip: Social media includes: website, Facebook/Instagram, newsletters, etc. Please select no if your child is in the Foster Care system.

Does your child: (please select all that apply) *

Additional Comments: