Parent's Full Name:

Child's Full Name:

Street Address:

City:      State:     

ZIP:      Phone:     

Email:

Child's Birthdate (day/mos/yr):

Child's Gender: Male    Female

Regular Attendee of Daystar?: Yes    No

If not, where?

How did you hear about Kidfest 2012?
(check all that apply)
Facebook/Twitter    Church Website
Newspaper/Radio Ad    Invite Card/Flyer by Mail
Friend    Carmike Theater Promo
Billboard/Road Sign    Daycare/School
Other: (please specify below)