USO Day at Kings Dominion Registration Form Please fill out completely

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: