ENGAGE Bago Student Registration Form 2025/2026

Please fill out this form and click submit.

Student Information

Name

*

Address

*

Birth Date

*

Gender

*

Please select one option.

M F

Weekend Worship Attendance

*

Please select one option.

At Park Hills Other

Grade

*

School

*

Shirt Size

Please select one option.

Child Small Child Medium Child Large Child XLarge Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge Adult XXXLarge

Allergies/Medical Needs

Student Contact Information

Please enter the student email and cell phone contact information we can use as the primary way to communicate with the student.

Email

This address will receive a confirmation email

Cell Phone

*

Parent / Guardian Contact Information

Please fill in all the areas that apply.

Mom Name

Mom Cell Phone

Mom Email

This address will receive a confirmation email

Dad Name

Dad Cell Phone

Dad Email

This address will receive a confirmation email

Guardian Name

Guardian Cell Phone

Guardian Email

This address will receive a confirmation email

In the case of an emergency and the parent/guardian cannot be reached, please notify

Emergency Contact Name

*

Emergency Contact Number

*

Emergency Contact Relationship to Child

*

Other Information

Other Comments

Description

Please fill out this form and click submit.

Please Fix the Following

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