Use the form below to register for Jr. High nights! If you have any questions, Contact Theresa Kiene at

* Required

Child's Information

First Name *
Last Name *
Identifies as * Female    Male
Date of Birth * Month   Day   Year 
Grade *
Child's Phone

Special Needs and/or Information We Should Know

Parent's Information

Full Name of Parent *
Address *
City *  St *  Zip *
Email *
Emergency Phone *

Stuff here too, including photos.