Kids Club 2017 Registration
Friday 6-8 pm: May 12- September 22 2017
Northcote Baptist Church, 67 Eban Ave, Hillcrest
Contact us at (021) 02943457 or kidsclub@nbc.org.nz
Email address *
First Name *
Your answer
Family Name
Your answer
Date of Birth
Your answer
Year at School
Name of school attended *
Your answer
Dietary restrictions *
Parent 1 Name *
Your answer
Parent 1 phone number (pref cell)
Your answer
Parent 1 email address
Your answer
Parent 2 Name
Your answer
Parent 2 phone number (pref cell)
Your answer
Parent 2 email (only if you require us to send to both)
Your answer
Emergency contact - note, we require a total of at least 2 cell phone numbers, including those above.
Your answer
Allergies/Medical information *
Your answer
Are there any behavioural issues that would be helpful for us to know about?
Your answer
Do you regularly attend a church?
Payment method *
Do you require a receipt? *
Any other information
Your answer
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