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Bergfeld EMMC DVBS Registration
Aug 12-16
,
2024
a
t
Bergfeld EMMC Church
1-4pm
If you have any questions, you can email Ang
dueckang@gmail.com
or text/call 204-324-4335
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Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Name of Parent/Guardian
*
Your answer
Parent/guardian phone number (home & cell)
*
Your answer
Parent/guardian email
*
Your answer
Name of emergency contact
*
Your answer
Emergency contact phone number
*
Your answer
What grade will your child be in the fall? (select only one)
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Required
Does your child have any allergies? If yes, please specify.
*
Your answer
Bus Transportation from Altona required? (Bus will leave Altona EMMC daily at 12:30pm and return around 4:15pm.
*
Yes
No
By signing, I as parent/guardian of the child agree that all DVBS Volunteers, Leaders and Bergfeld church are not liable for injuries on premises and during bus ride to and from DVBS Aug 12-16, 2024.
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