Connect Child Registration

Connect @ Grace Church Bothwell

Registration Form for Children's Club
Name

First NameLast Name
Birth Date

MonthDayYear
Address
Please use this space to indicate any relevant information about your child. Any health concerns / allergies?
Primary Contact Number*
Additional Contact Number*
Relationship to Child
Please Acknowledge the Following:

I am aware that Connect Children's Club is an outreach of Grace Church Bothwell and that it will sensitively and appropriately teach aspects of the Christian faith.For publicity reasons, there may be occasional photographs taken of groups of children to record various aspects of the club and for appropriate use on the facebook page.I consent to giving Grace Church Bothwell this information which will only be used for the purposes of the Connect Children's Club.I give permission for any necessary medical treatment to be given by the named First Aider.
Signature

Clear
Should be Empty: