HALLELUJAH NIGHT REGISTRATION 20___
(Form only required for Children ages 12 & under)

                                        Child/Children’s:   Name__________________________Age______

                                                            Name__________________________Age______

                                                            Name__________________________Age______

                                                                    Name__________________________Age______ 

                                                                    Name__________________________Age______

                                        Parent’s Name______________________________________________

                                        Address____________________________________________________

                                        City____________________  State_______  Zip________      

                                        Phone Number_____________________________________________

                                        Email Address_____________________@_______________________

                                        Church you attend_________________________________________