Summer Good News Club

Summer Good News Club Registration:

* Indicates required field

Child's Name #1 *

First

Last

Age *

Child's Name #2 *

First

Last

Age *

Child's Name #3 *

First

Last

Age *

Child's Name #4 *

First

Last

Age *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian's Name *

First

Last

Relation *

Emergency Phone Number *

Email *

Parent/Guardian's Name *

First

Last

Emergency Phone Number *

Relation *

Email *

Additional People Who Can Pick Up Your Child:

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Any Allergies? *

Yes No

List the Allergies *

Can we take a pictures of your child and put it on the church's webpage and church's facebook? *

Yes No

Who Fill this Out:

Parent/Guardian's Name *

First

Last

Relation: *

Submit