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Participant Registration

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Registro en Español

Evangelical Reformed Church

Location

7435 S. Madison

Tacoma, WA 98409

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Contact Sonja West:

sonja@nutley.org

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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NOTE: At the bottom of this Parent Information section there is an advertisement about receiving information from Group Publishing. If you are not interested in that, you should un-check the box.

Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Home Church Affiliation

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Comments

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Tell Us About Your Participant

First Name

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Last Name

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The Pre-K (or Preschool) class is for the younger siblings of children who are attending Bible Day Camp. These children must be 3 or 4 years old and not entering Kindergarten. (If entering Kindergarten, they should register for the Kindergarten class.) If the child is 2 years old, parents must confirm with Joanna Adkins (the Preschool class teacher) that the child is mature enough for the class.

Grade Entering

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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Comments

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