Power Lab
Discovering JESUS' Miraculous Power
Where: St. Elizabeth Ann Seton
June 23rd - 27th (Monday - Friday)  6:00 PM - 8:30 PM
Cost: $15.00/$25.00 a family 

Child's name: ___________________________________________________Age ________

Street address_____________________________________________________________________

City ___________________________________ State _______________ Zip ______________

Home Telephone: _________________________________________

Parent/caregiver's cell phone _________________________________

Home e-mail address _____________________________________________________________

Date of birth ____________________________________________________________________

Last school grade completed _______________________________________________________

In case of emergency, contact ______________________________________________________

*Someone I would like in my crew __________________________________________________

Mother ______________________________________________________________________

Father _______________________________________________________________________

Other _______________________________________________________________________

Allergies or other medical conditions_________________________________________________

____________________________________________________________________________

Parish ____________________________________________________

Lab Crew number (for parish use only)  MAKE CHECKS PAYABLE TO:  SEAS

Mail registration to: SEAS Church, 
2200 W. Republic Rd., 
Springfield, Mo.  65807  
Attn: Debbie Randell