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Address

Faith CRC

1070 S Prospect Ave

Elmhurst, IL 60126

Contact

Time & Dates

630-279-1776

GEMS@faithelmhurst.org

2nd & 4th Wednesdays

6:30 - 8:00 pm

GEMS Registration

Registrant

First name*

Last name*

Birthday*

Month

Day

Year

Grade

1st

2nd

3rd

4th

5th

6th

7th

8th

T-Shirt size

YS

YM

YL

Adult S

Adult M

Adult L

Adult XL

Address

Multi-line address

Country/Region

Address

City

Zip / Postal code

Mother's Name

First name*

Last name*

Mother's phone number*

Mother's email

Father's Name

First name*

Last name*

Father's phone number*

Father's email

Emergency Contact (other than parent)

First name*

Last name*

Phone number*

Relationship to student*

Additional comments (allergies, drug reactions, medical history, etc)

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