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]