Holiday Bible Club 2019 Registration Form

Child's Name*
First Last
Date of Birth*
School Year*
Sex*
- Male
- Female
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Contact Phone Number
Second Contact Phone Number
Any allergies / medical conditions that we should be aware of:
Sometimes we may wish to use photographs of group activities / general scenes taken during the club on our church website and Facebook page. Please indicate if you would prefer us NOT to publish pictures of your child as part of a group.
- Do Not Publish Photos of my Child
In case of illness or accident, I give permission for any necessary medical treatment to be given by the nominated first-aider. If I cannot be contacted in an emergency I am willing for my child to receive hospital treatment, including anaesthetic if necessary.
Name of Parent / Guardian*
First Last
Email*
Signature
Phone
This field is for validation purposes and should be left unchanged.