Please fill out the information below to register your child for Great Escape.
A non-refundable deposit is required upon submission of this registration to hold your child's spot (choose deposit amount in the 'Price' dropdown at the bottom of this page).
Please list any allergies, health conditions, or development delays/ diagnosis/ therapy that you are aware of?
*Parent 1 Relationship to Child:
*Parent 2 Relationship to Child:
*Are your or your spouse on staff at Southland Christian Church?
Provide information for two emergency contacts other than the parents.:
Special Pickup Instructions:
*Are there any special circumstances regarding custody or court orders regarding this child?
If yes, please include details below.
By submitting this registration, you are affirming that all information is correct to the best of your knowledge, and you agree to promptly notify the Great Escape Director's office of any changes to this information.