Child's Info
Child's name
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Child's surname
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Child's date of birth
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/
DD
/
YYYY
Child's current age
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Child's grade
Child's school
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Child's home church
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Child's gender
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Allergies
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Comments
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Parents Info
Parent Email Address
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Parent 1 Name
Your answer
Parent 1 Surname
Your answer
Parent 1 Cell Phone No
Your answer
Parent 2 Name
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Parent 2 Surname
Your answer
Parent 2 Cell Phone No
Your answer
Emergency contact person
If neither parent available
Your answer
Emergency contact number
If neither parent available
Your answer
Home physical address
Your answer
How did you hear about Holiday Club?
Disclaimer
Please agree to the disclaimer below to complete the registration
* I hereby allow my child to participate in the activities of the Holiday Club and will not hold Eastside Community Church or its leaders responsible in the case of injury, theft or damage to goods. * I give permission for photos taken to be used on social media and the church newsletter.
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