2025 MMBC Summer Kids Club Registration
For ages 5-10
Child Name
*
First Name
Last Name
Age
*
Gender
*
Girl
Boy
Does your child have any allergies? If yes, please list them below:
*
Does your child have any medical condition that we should be aware of? If yes, please explain below:
*
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Parent / Guardian Information
Name
*
First Name
Last Name
Relationship to Child
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Emergency Contact
*
First Name
Last Name
Secondary Emergency Contact Phone Number
*
Please enter a valid phone number.
Please list any additional authorized people who are allowed to pick your child up in the event you're unavailable.
*
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Terms and Conditions
I allow my child to participate in Mullen Memorial Baptist Church's Summer Kids Club for the following dates of July 22, 29, and August 5 2025.
I hereby authorize Mullen Memorial Baptist Church and their volunteer personnel to conduct first aid and basic medical care in the event of an emergency situation. I agree to pay for all the medical care expenses and costs in a given situation that medical care is needed.
I release Mullen Memorial Baptist Church, their volunteers, and all other approved entities from any liabilities that might happen during MMBC Summer Kids Club, and hold them harmless in the event of damages, injuries, or accidents.
I confirm that all information in this form is accurate and true to the best of my knowledge.
Do you allow the MMBC to take photos or videos during the activities of your child for advertising and marketing purposes that will be posted on social media and church website?
*
Yes
No
Parent/Guardian Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: