USO Day at Kings Dominion
Registration Form
Please fill out completely NLT 14 June 2008
Military Members
Name
First
 Last
Rank
Unit
 Installation
 Commander's Name
Unit Phone Number
Air Force
 Army
 Navy
 Marine
Coast Guard
Street
 City
 State
 Zip Code
Phone Number
 Email Address
Spouse
1st Child
 Age
2nd Child
 Age
3rd Child
 Age
4th Child
 Age
5th Child
 Age
Adult
Indicate number of each size
needed:  (one per adult please)
M
 L
XL
 XXL
S
Child
Indicate number of each size
needed:  (one per adult please)
XS
 S
 M
 L
EFM Child Information
Child's First Name
 Child's Last Name
Child's Diagnosis (for EFM Status)
Does Child Require a Wheel Chair from the Park?
Yes
Please list any special medical needs the Park may need to know.
I give my consent for my family to be photographed
for use in the military/local papers and web sites.
Yes
No
Service Members Rank
Duty Station
Branch of Service
Home Address:
Phone / Email

Family Member Names

T-shirt sizes
(one for each participant)

Exceptional Family
Member
(Qualifying EFM child)

Consent to be
photographed: