Tuesday - Thursday, June 25 - 27, 9:00am - 12:00pm Four year olds - entering Grade 6
REGISTRATION FORM Please email, drop off, or fax registration form to: First Reformed Church/La Casa de mi Padre • 3060 Wilson Avenue • Grandville MI 49418 Phone: 616-534-5465
Fax: 534-1185 Email: mail@firstgrandville.org
Register by June 17, 2019 for planning purposes, however registration will also be accepted at the door if room is still available. Name
Speaks Spanish
Age
Grade Entering Sex
Allergy / Health Information/Special needs
______
____
____________
___
_________________________________________
2.__________________________________
______
____
____________
___
_________________________________________
3.__________________________________
______
____
____________
___
_________________________________________
4.__________________________________
______
____
____________
___
_________________________________________
5.__________________________________
______
____
____________
___
_________________________________________
6.__________________________________
______
____
____________
___
_________________________________________
1.__________________________________
Parent Names______________________________________ Address_______________________________________________________ Email_____________________________________________ City____________________________________ Zip_________________ Home Phone_________________________
Work Phone_____________________ Cell Phone_________________________________
Emergency Contact________________________________________________ Emergency Phone________________________________ My child has my permission to participate in and have photos published for multicultural bilingual “”Roar! Life is Wild
God is Good”
VBS Program at First Reformed Church/La Casa de mi Padre Tuesday - Thursday June 25-27, 9:00-noon. Parent Signature_________________________________________________________ Date__________________________________________
Martes a Jueves del 25-27 de Junio, a las 9:00-12:00 FORMULARIO DE REGISTRACION 4 anos hasta 6th grade por favor envie por correo electronico o por fax el formulario de inscripcion a: First Reformed Church/La Casa de mi Padre 3060 Wilson Avenue Grandville MI 49418 telefonos:616-312-6284 Fax: 534-1185 Correo electronico: mail@firstgrandville. Registrarse antes del 17 de Junio,2019 para fines de planificacion, las incripciones tambien sera aceptadas en la puerta si aun hay espacio. nombre
sexo alergias/info de salud/necesidades especiales
____
______
____
_____________________________________
2.___________________________________ _____
____
______
____
_____________________________________
3.___________________________________ _____
____
______
____
_____________________________________
4.___________________________________ _____
____
______
____
_____________________________________
5.___________________________________ _____
____
______
____
_____________________________________
6.___________________________________ _____
____
______
____
_____________________________________
Nombre de los padre____________________________________________ Direccion___________________________________________ Correo Electronico ______________________________________________Ciudad ________________________________ zip__________ Telefono de la casa _______________________Telefono del trabajo ________________________Celular __________________________ Contacto de emergencia_________________________________________Telefono de emergencia :________________________________ Mi hijo tiene mi permiso para participar en y tener fotos publicadas por el programa multicultural bilingue " Make Fun Factory VBS" en la iglesia First Reformed Church/La Casa de mi Padre, Martes a Juevess del 25-27 de Junio, a las 9:00-12:00. Firma de los Padres________________________________________________________ Fecha__________________________________
