Bull Creek Kids Registration - Westminster Presbyterian Church Bull Creek

Surname *

Given Name *

Date of Birth *

Gender *

School Year *

School Attending *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian Name *

First

Last

First

Last

Parent/Guardian Contact Number *

Parent/Guardian Email Address *

Does the attendee have any allergies? *

Please list allergies *

Does the person attending have any medical conditions? *

Please list medical conditions *

I consent that WPCBC may take photos and/or video footage of my child/ward for the WPCBC website/newsletter/other publications *

I consent that WPCBC may publish photos and/or video footage of my child/ward for the WPCBC website/newsletter/other publications *

Signature of Parent/Guardian *

Date *