Messy Church Registration Form - Sunday 12th December 2021

Messy Church Registration Form

Sunday 12th December 2021 11:40am - 1:40pm @ Killead Presbyterian Church (Closing date for registration - Friday 10th December 2021)
Name of Parent/Guardian completing registration form*

First NameLast Name
Address

Street Address Line 1

Street Address Line 2

TownCounty

Post Code
Parent's/Guardian's E-mail
example@example.com
Parent's/Guardian's Mobile Number
Name of Child attending *

First NameMiddle NameLast Name
Child's Date of Birth*

MonthDayYear
Medical and/or Dietary Info *
Name of additional child attending (if applicable)

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Medical and/or Dietary Info
Name of additional child attending (if applicable)

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Medical and/or Dietary Info
Name of additional child attending (if applicable)

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Medical and/or Dietary Info
Names of ALL adults attending Messy Church on Sunday 12th December 2021
Supervision*
Additional Information (if relevant)
I give my permission for my child's/children's photographs to be taken and used on the churches' websites and Facebook pages. *
I would like to receive information about future events for children, young people and families. *
Signature

Clear
Should be Empty: