2018/2019 JAM Registration
CB Salem Jam Registration for 2018/2019
Child's Name *
Your answer
Sex *
Age *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Grade Entering Fall of 2018 *
Your answer
Allergies
Your answer
Special Needs
Your answer
Parent/Guardian Name *
Your answer
Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Home Phone *
Your answer
Emergency Contact *
Your answer
Relationship of Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
I Would be willing to help out with JAM *
I will allow my child's photo to be used in church publications, press releases, and on the church website or Facebook page. *
Is there anyone who should NOT have contact or access to your child? *
If yes, who?
Your answer
I will give permission for my child to receive communion during JAM worship time. *
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