Kids Klub Registration Form

Acton UMC Summer Kid's Klub

Have your kids, 4yrs old through 5th grade, join us on Wednesdays in June and July from 10-12:30pm for games, crafts, Bible lessons, music, and fun! Lunch will be provided, and this event is free. Please call 317-862-2588 if you have any questions. The fun starts on June 10.
Registration

You can register up to 5 children in the same household on one form.
Parent/Guardian Information
Family Contact

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your home church, if you have one?
Are you interested in volunteering time or supplies for Kids Klub?
Emergency Information
Emergency Contact's Name (if parent cannot be reached)

First NameLast Name
Phone Number
Format: (000) 000-0000.
Who is allowed to pick kids up from Kids Klub besides parent or emergency contact?

First NameLast Name
Attendee #1
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Shirt Size
Dates child will be attending.
Attendee #2
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Shirt Size
Dates child will be attending.
Attendee #3
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Shirt Size
Dates child will be attending.
Attendee #4
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Shirt Size
Dates child will be attending.
Attendee #5
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Does the child have any allergies, a chronic illness, or medical conditions? If yes, please describe.
Shirt Size
Dates child will be attending.
Should be Empty:

Acton UMC Summer Kid's Klub

Registration