Quest for Rest Registration Forms

Quest for Rest
Spring Respite Night
April 25 6-9 PM
REGISTRATION
PARTCIPANT REGISTRATION: Please print in ink. Please use a separate form for each participant.
Participant Name __________________________________Age_________Birthday ____________________
Circle one: Male Female
Grade: _________
Parent or Guardian Names ___________________________________________________________________
Parent or Guardian Home Phone ___________________________Cell Phone _______________________
Parent/Guardian Email address:______________________________________________________________
 Participant has attended a previous Quest for Rest at Abundant Life and there are no
changes to the Plan of Care.
 Participant has attend a previous Quest for Rest at Abundant Life and there ARE changes to
the Plan of Care.
Please list 2 emergency contacts in the event the parent or guardian cannot be reached.
Name ____________________________Relationship _______________Phone # _______________________
Name ____________________________Relationship _______________Phone # _______________________
Medical conditions or allergies (Plan of Care document will be required for each participant)
_____________________________________________________________________________________________
SIBLING REGISTRATION: Will Participant’s Sibling attend the SIBLING Quest for Rest Night? Y N
If yes please complete the information below for each sibling attending.
Sibling Name __________________________________Age_____________Birthday ____________________
Male Female
Grade: _________
Sibling Name __________________________________Age_____________Birthday ____________________
Male Female
Grade: _________
PARENT/CAREGIVER NIGHT OUT:
We are offering a free special meal (free) and an evening of fun for all parents and caregivers
the same evening at the Core.
Will you be attending? Y N
If yes, how many should we plan for?______________
How did you hear about Quest for Rest?______________________________________________________
Parent/Guardian’s Signature _______________________________________Date ____________________
Please return completed form to Abundant Life Children’s Wing Check-In Desk (Sunday’s), Abundant Life
Church office (M-F 9:00am-4:30 pm) ,email to [email protected] or fax 816-554-8192.
Questions: Please contact Sara Harrell (816-607-5840 or [email protected])
414 SW Persels Rd, Lee’s Summit, MO 816.554.8181
www.abundantlifewired.com/specialneeds
[email protected]