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:
[email protected]
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
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Grade Entering Sex
Allergy / Health Information/Special needs
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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
hablo espanol 1.___________________________________ _____
edad
grado
sexo alergias/info de salud/necesidades especiales
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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__________________________________
