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Participant Registration

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Registro en Español

SOUTH UNION CHRISTIAN CHURCH

Location

6510 S. ROCKPORT RD,

BLOOMINGTON, IN 47403

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Contact Jackie Goss:

812-824-1829

jackie.goss@gmail.com

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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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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Alternate Pickup Name

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Alternate Pickup Phone

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Home Church Affiliation

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Comments

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*Completing the below registration for my child, indicates I have read the Medical and Photo Release Form and authorize medical treatment and photo use as outlined per agreement. Should I have any concerns, I will make comments in the comment section below.

Medical and Photo Release Form

Medical and Photo Release nonconsent/concerns

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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T-shirt sizes are pre-ordered so shirt sizes are not guaranteed! They are first come first serve based on registration date. We will do our best to make sure all kids receive the size requested!

Shirt Size

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Allergies

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Medical Concerns

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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Comments

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