Kids Klub Registration Form

Acton UMC Summer Kid's Klub

Have your kids, 4yrs-5th grade, join us on Wednesdays in June and July from 10-12:00pm 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.
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*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you interested in volunteering time or supplies for Kids Klub?

YesNo
Emergency Information
Emergency Contact's Name (if parent cannot be reached)*

First NameLast Name
Phone Number*
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*

Child's XSChild's SChild's MChild's LChild's XLAdult XSAdult SAdult M
Dates child will be attending.*

June 4June 11June 18June 25July 9July 16July 23
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

Child's XSChild's SChild's MChild's LChild's XLAdult XSAdult SAdult M
Dates child will be attending.

June 4June 11June 18June 25July 9July 16July 23
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

Child's XSChild's SChild's MChild's LChild's XLAdult XSAdult SAdult M
Dates child will be attending.

June 4June 11June 18June 25July 9July 16July 23
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

Child's XSChild's SChild's MChild's LChild's XLAdult XSAdult SAdult M
Dates child will be attending.

June 4June 11June 18June 25July 9July 16July 23
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

Child's XSChild's SChild's MChild's LChild's XLAdult XSAdult SAdult M
Dates child will be attending.

June 4June 11June 18June 25July 9July 16July 23
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Acton UMC Summer Kid's Klub

Registration