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Registracion del Participante

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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

Primero, cuéntenos sobre usted:

Información de los Padres

Nombre

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Apellido

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Correo Electrónico

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Dirección 1

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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Teléfono de Contacto 1

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Nombre del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Nombre de recogida alternativo

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Teléfono de recogida alternativa

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Afiliación de la iglesia local

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Comentarios

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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.

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Cuéntanos sobre tu participante

Nombre

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Apellido

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Grado Saliendo

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Género

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Fecha de nacimiento

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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!

Talla de Camisa

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Alergias

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Preocupaciones Médicas

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¿Tienes amigos con los que te gustaría estar juntos? Haremos todo lo posible para juntar a los amigos seleccionados en el mismo grupo, pero no podemos prometer que todas las solicitudes serán posibles.

Amigo 1 Nombre

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Amigo 1 Apellido

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Amigo 2 Nombre

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Amigo 2 Apellido

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Amigo 3 Nombre

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Amigo 3 Apellido

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Comentarios

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