Summer Fun Days Registration Form

Summer Fun Days Registration Form
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
E-mail
Parent(s) Name(s)*
Parent(s) Work Phone(s)

Area CodePhone Number
Area CodePhone Number
In Case of Emergency Contact*
Allergies/Other Issues
School Grade Just Completed*
Name of Home Church, If Any
I hereby ________ permission for First Christian Church and First Presbyterian Church of Macomb to use pictures of my child on its website for informational or promotional purposes.*

GRANTDO NOT GRANT
I am the parent or legal guardian of the above listed child, and by clicking Submit I am confirming that all of the above information is correct.*

I AgreeI Disagree
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