MARK Club Registration for College Street Baptist Church
Begins September 9, 2018 ~ 5:00pm-6:30pm ~ Age 4 - Grade 5 ~ CSBC Family Life Center ~ Must be at least 18 years to fill out and submit this form (List up to 3 children on this form)
Child #1 Name *
First and Last Name
Your answer
Child #1 Please list any food allergies that your child has: *
Your answer
Child #1 Please list any allergies/concerns that your child has: *
Your answer
Child #1 Current Grade *
Child #2 Name
First and Last Name
Your answer
Child #2 Please list any food allergies that your child has:
Your answer
Child #2 Please list any allergies/concerns that your child has:
Your answer
Child #2 Current Grade
Child #3 Name
First and Last Name
Your answer
Child #3 Please list any food allergies that your child has:
Your answer
Child #3 Please list any allergies/concerns that your child has:
Your answer
Child #3 Current Grade
Parent/Guardian Name *
First and Last Name
Your answer
Complete Address/Apartment # *
Street Address with Apartment #, City, SC
Your answer
Cell Phone # *
Your answer
Home Phone #
Your answer
Email Address *
Your answer
OK to Photo/Video Your Child for MARK Club Related Purposes? *
Person(s) authorized to pick up your child *
Your answer
In Case of Emergency Contact Name *
First and Last Name
Your answer
Emergency Contact Phone # *
Your answer
Parent/Guardian Signature *
Submitting this form will serve as parent/guardian signature that your child (children) can attend College Street Baptist Church MARK Club Program 2018-2019 school year and permission to ride the church bus if applicable. Please type your First and Last Name
Your answer
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