Events

Families, please complete one form per child.

Child’s name

First

Last

Gender*

Child’s Grade (Fall 2010)

Child’s Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Parent’s/Guardian’s Name

First

Last

Parent’s/Guardian’s Phone

###

####

Second option

###

####

Persons to be contacted in case of emergency:*

First

Last

Name

First

Last

Phone Number

###

####

Name

First

Last

Phone Number

###

####

Email*

Does your child have any medical condition(s) that
we should be aware of?*

(allergies, medications, etc.) If so, please
explain:*

I would like to volunteer to help with: (check all
that apply)

Crafts

Games

Snacks

Being a group leader

(Check box if you agree) :By signing this
registration form you agree that any photographs
taken of your child at or during this event are
the property of The Main Place Christian
Fellowship and may be used in future publications
as deemed appropriate.*

Check

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