BAM Registration

BAM Registration
Kindergarten - 5th Graders | Wednesdays 6:00 - 7:30pm

SPRING 2019 SESSION: January 16 - February 27

FAMILY NIGHT: March 6th
Parent/Contact Name *
Email *
example@example.com
Cell Phone (in case we need to contact you during the event time) *

- Area Code Phone Number
_______________________________________________________________
I give consent for the church/event staff to use their own judgment in securing EMERGENCY medical aid

and/or ambulance service for children listed on this form if for any reason the parents or emergency contact person cannot be reached.

By entering your name below you agree to the above statement and authorize South Rock Christian Church to make the decisions mentioned.
Parent Signature
_______________________________________________________________
Emergency Contact Name
Emergency Contact Phone

- Area Code Phone Number
Emergency Contact Relationship to Participants on this form
_______________________________________________________________

Information for first child from family
Child's Name *
Child's DOB *

- Month - Day Year
Date
Gender *

Male Female
Grade *

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
Allergies or other additional comments

_______________________________________________________________

Optional Information
Are you currently attending an SRCC Small Group?

Yes No
If so, please enter Leader's names
If so, please enter the day of week and time you meet:
Should be Empty: