INTERMISSION REGISTRATION
This registration for the 2017-18 INTERMISSION program at Wichita First Church of the Nazarene. Please fill out completely and submit.
Child's Name
Your answer
Child's Grade
Child's Birth Date
MM
/
DD
/
YYYY
Gender
Child's Address (street,city, state, zip)
Your answer
Parent Email:
Your answer
Parent/Guardian #1 Cell Phone
Your answer
Parent/Guardian #2 Cell Phone
Your answer
My child plans to participate in the home based Caravan Program:
PARENT E-SIGNATURE: The below signature states that the Parent/Guardian of the above child is allowed 1)to be treated by the WFC Kids Staff in case of injury and/or emergency and 2) to be taken off campus for any INTERMISSION activities beyond the church property.
Your answer
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