LIFE Registration
Last Name
Mother Father
Address
City & Zip Phone ( )
E-mail Fax ( )
Names of Children Age (as of 9/05) Grade (9/05)
----------------------------------------------------------------------------------------------------------------------------
E-mail Coordinator (all registrants please complete this section)
Name of Teaching Parent:
Phone Number: ( ) E-mail address:
-----------------------------------------------------------------------------------------------------------------------------
Mailbox Coordinator (all registrants please complete this section)
Name of Teaching Parent:
Address: City & Zip:
Phone Number: ( ) E-mail address:
-----------------------------------------------------------------------------------------------------------------------------
1. Make $25 registration checks payable to: Candee Olk
2. Please self-address 10 mailing labels and turn them in with your registration form and payment to Carrie Bellue