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Kiokee Baptist Church

Declaring. Loving. Reaching. Discipling.

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DNOW Registration

This registration is for: *

a student.
an adult leader.

Registrant's Name: *

First

Last

Contact Phone Number: *

Contact Email (to receive a registration confirmation): *

Grade (if student)

Is this your first Kiokee Students event? *

Yes
No

Shirt Size (all shirts are in adult sizes): *

Does the participant have any known allergies? *

Yes
No

Please list allergies:

Does the student require any medication? If so, please list details below:

Emergency Contact Information

Please enter the name of the emergency contact in the event of an emergency.

Relationship: *

Parent
Grandparent
Spouse
Other

Name: *

First

Last

Emergency Contact Phone: *

Emergency Contact Email: *

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PO Box 430
2520 Ray Owens Rd.
Appling, GA 30802
Phone: (706) 541-1086
Fax: (706) 541-9348

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