Indonesian Sunday School 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

Mother's Name *

First

Middle

Last

Mother's Email Address *

Mother's Mobile Number *

Father's Name *

First

Middle

Last

Father's Email Address *

Father's Mobile Number *

Parents' Home Address *

Does your child suffer from any allergies? *

If yes, please list the allergies *

Does your child suffer from any learning difficulties or medical issues that we need to consider? *

If yes, please list the conditions *

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

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

Signature of Parent/Guardian *

Date *