Copy of 5-Day Club - June 22nd-26th

Child's information

Name

Address

Phone

Grade Completed

Age

Medical Information and Allergies

Does this child attend Sunday school? If so where?

Parent or Guardian Information

Parent or Guardian Name

Phone

This address will receive a confirmation email

Emergency Name and contract phone number, (other that the one listed above)

May we have permission to photograph your child? AND May we have permission to use your child's photograph for the purpose of promotion?

Yes No

Who may pick your child up at the end of each day of 5-Day Club?

Address

NOTICE: The parent, guardian or designated person in this form needs to drop off the child every time and will need to pick up their child.

Description

June 22nd - June 26th / 10AM-11:30AM, Lunch Follows

5-Day Club
Monday-Friday