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Blooming Glen Mennonite Church Summer Bible School Registration
Date: July 17-21, 2017
Time: 9:00 am - 12:00 pm
Location: Blooming Glen Mennonite Church, PO Box 238, Blooming Glen, PA 18911
Contact us at: 215-257-3431 or
kim@bgmc.net
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Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Select Grade Completed (as of July 2017)
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Preschool begins at age 3
Preschool (Currently still in Preschool)
Preschool (Completed Preschool)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Date of Birth
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mm/dd/yyyy
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Age
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3 years
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5 years
6 years
7 years
8 years
9 years
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11 years
12 years
13 years
Gender
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Parent/Guardian's Name(s)
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Street Address
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PO Box or Apartment #
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City, State, Zip Code
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Phone Number(s)
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Email Address
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Home Church
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Special Needs/ Allergies
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Is there a friend your child would like to be with?
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Please check one of the options below:
*
I give permission to Blooming Glen Mennonite Church to take photographs and/or video of my child for use in the church newsletter, on the BGMC website, on the BGMC Facebook page, and/or at retirement homes.
I do not give permission for my child to be photographed or video taped. (This will mean that your child will not receive a group photo or be part of the daily slideshow that is shown at SBS.)
Emergency Contact Person
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Emergency Contact's Phone Number
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Anything else you would like us to know?
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