Wednesday Night Chelten Kids! Registration 2018-2019
Our Wednesday night programs run from September through April. There is no registration fee! On opening night, we will provide you with more information regarding any possible program costs throughout the year, this would include the fall retreat. We look forward to a great year learning about Jesus!
Which program is your child registering for? *
Master Builders is for boys in grades 1st-5th, Explorer Girls is for girls in grades 1st-5th
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Birthday *
MM
/
DD
/
YYYY
Child's gender
Grade level for the 2018-2019 school year *
What school does your child attend?
Your answer
Parent(s) or Guardian(s) name *
Your answer
Child lives with...
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone Number
Your answer
Parent/Guardian Cell Number *
Your answer
Parent'/Guardian email *
Your answer
Allergies, Medical Concerns, & Special Needs
Please let us know if there are any concerns or needs that we need to address? From peanut allergies to IEPs. the more information you give us the more we can meet the needs of your child.
Your answer
May we have permission to administer basic first aid if needed? *
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name
Your answer
Emergergency Contact #2 Phone Number
Your answer
Doctor Information *
Please tell your child's doctor, address, and Phone number
Your answer
Insurance Information *
Please list your insurance company, Group #, and policy #
Your answer
Authorized Pick-up Person #1
Your answer
Authorized Pick-up Person #2
Your answer
Authorized Pick-up Person #3
Your answer
Authorized Pick-up Person #4
Your answer
Is there anyone who is not allowed to pick up your child?
Your answer
May we have permission to photograph your child for church publications including internet and chelten's social media accounts? *
We mainly take pictures for our end of the year slide presentation.
If your family attends church, where do you attend?
Your answer
Would you be willing to help with our program in some way?
Pleae check any that might apply to you
Additional Comments
Your answer
Child's T-shirt size
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