JOY Club Registration form

JOY Club Registration Form

1st Baptist Church of Rowley MA
Parent Name(s) *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Mailing Address

Street Address

Street Address Line 2

City State

Zip Code
Child's Name *

First Name Last Name
Child's Birthday *

Month Day Year
Child's Teacher *
Teacher Last Name
Child's Grade *
Emergency Contact *

First Name Last Name
Emergency Phone Number *

Area Code Phone Number
COVID-19 *

I have read the COVID-19 safety protocols, included with the parents letter sent via email, and have discussed the protocols with my child(ren).
I would like my child(ren) to wear a mask during indoor activites *

YES NO
Allergies: (child's name, allergy, and required medication)
PERMISSION FORM *

I give permission for my child listed above to attend JOY Club at 1st Baptist Church, Rowley, MA. during the 2021-2022 school year. In the unlikely event of an emergency, I give permission for my child(ren) to be treated by an accredited physician or emergency medical technician. (You will receive a call immediately if there is an emergency.) I give permission for my child(ren) to walk from Pine Grove School (PGS) to the First Baptist Church at 147 Main St., Rowley, MA with JOY Club leaders. In inclement weather, I give permission for my child to receive transportation by JOY Club leaders from PGS to First Baptist Church. I give permission for my child to be photographed for craft purposes.
Signature

Clear
Should be Empty:

JOY Club Registration Form