Tuesday - Friday, July 25 - 28, 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:
[email protected]
Register by July 10, 2017 for planning purposes, however registration will also be accepted at the door if room is still available. Name
Age
Grade Entering Sex
Allergy / Health Information/Special needs
1.__________________________________
____
____________
___
_________________________________________
2.__________________________________
____
____________
___
_________________________________________
3.__________________________________
____
____________
___
_________________________________________
4.__________________________________
____
____________
___
_________________________________________
5.__________________________________
____
____________
___
_________________________________________
6.__________________________________
____
____________
___
_________________________________________
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 “Maker Fun Factory” VBS VBS Program at First Reformed Church/La Casa de mi Padre Tuesday - Friday, July 25-28, 9:00-noon. Parent Signature_________________________________________________________ Date__________________________________________
Martes a Viernes del 25-28 de Julio, 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 10 de Julio,2017 para fines de planificacion, las incripciones tambien sera aceptadas en la puerta si aun hay espacio. nombre
edad
grado
sexo alergias/info de salud/necesidades especiales
1.___________________________________________
____
______
____
_____________________________________
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 Viernes del 25-28 de Julio, a las 9:00-12:00. Firma de los Padres________________________________________________________ Fecha__________________________________
