Live Nativity

Child First Name *

Child Last Name *

Birthday * +

Gender *

Female

Male

Grade *

Some children will be in contact with live animals. Please list any allergies. *

Parents/guardians of participants are advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the Division of Youth and Young Adult Ministry or the Archdiocese of Baltimore. (Participants would be not identified, however, without specific written consent.) I acknowledge and accept the above statement. *

YES

Emergency Contact Information

First Name *

Last Name *

Phone Number *

Relationship *

Parent/Guardian Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *