Enrol for Holiday Bible Club January 2020
Holiday Bible Club: Tues 14 & Wed 15 January 2020

131 Gunnedah Road, Taminda, Tamworth NSW
Contact us: Sam Blaxland 0491 119 982

Sponsored by Tamworth Bible Baptist Church
Free Entry | Ages 6-13
Which days will the child(ren) be attending? *
Child's information
First and last name *
Your answer
Gender *
Date of birth *
Your answer
Child's medical details
Does the child suffer from (please tick) *
If you have ticked any of the medical conditions listed, please provide further information regarding the condition and the administration of any medication in the space provided.
(eg. Asthma - 2 puffs of Bricanyl to be taken at 9 am) Please note: Scheduled medication must be provided in the original container (as required by legislation).
Your answer
Medicare number *
Your answer
Position on card *
Your answer
Valid until *
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Child's dietary information
If your child has special dietary requirements, please provide the necessary information in the space provided.
Your answer
Enrol a second child?
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