General Information

Name of person completing this form:

First Name:*

Last Name:*

Are you the parent of the child you are registering?

YesNo

If 'no' then please provide the parent's first and last name

Contact Information

Child's Address:*

City:*

State:*

Zip:*

1 - Phone:*

If other:

2 - Phone:*

If other:

Email Address:

Church Affiliation

I do not attend church I am a member of Center Grove
I attend church elsewhereI would like more information about CGBC

If you attend church elsewhere please let us know where

If you are a member of Center Grove please provide your Keycard Number

Emergency Contact (if you cannot be reached)

1st number to call:*

this is:

Relationship to child:

2nd number to call:*

this is:

Relationship to child:

Registration

NOTE: Registered children must be at least age 3 and potty trained by June 22, 2009

Child's Name:*

Goes by:

Relationship to me:*

If other:

Birthday(MM\DD\YYYY):*

Last grade completed:

Does your child have special needs?

YesNo

If 'yes' please explain:

Does your child have any allergies?

YesNo

If 'yes' please explain:

My Child would like to be with (name of child):

If you're not registering another child please click here to skip the next steps.

(2) Child's Name:

Goes by:

Relationship to me:

If other:

Birthday (MM\DD\YYYY):

Last grade completed:

Does your child have special needs?

YesNo

If 'yes' please explain:

Does your child have any allergies?

YesNo

If 'yes' please explain:

My Child would like to be with (name of child):

If you're not registering another child please click here to skip the next steps.

(3) Child's Name:

Goes by:

Relationship to me:

If other:

Birthday(MM\DD\YYYY):

Last grade completed:

Does your child have special needs?

YesNo

If 'yes' please explain:

Does your child have any allergies?

YesNo

If 'yes' please explain:

My Child would like to be with (name of child):

Comments/Questions:

AFTER YOU CLICK THE 'SUBMIT' BUTTON BELOW, YOU SHOULD BE TAKEN TO A "THANK YOU FOR YOUR REGISTRATION" PAGE.

REGISTRATION IS NOT COMPLETE UNTIL YOU ARE TAKEN TO THE "THANK YOU" PAGE

If you are not taken to the "Thank You" page please review all required fields above.

Submit

* Required

Forms

Summer Adventure

AFTER YOU CLICK THE 'SUBMIT' BUTTON BELOW, YOU SHOULD BE TAKEN TO A "THANK YOU FOR YOUR REGISTRATION" PAGE.

REGISTRATION IS NOT COMPLETE UNTIL YOU ARE TAKEN TO THE "THANK YOU" PAGE

If you are not taken to the "Thank You" page please review all required fields above.

Forms

Summer Adventure

AFTER YOU CLICK THE 'SUBMIT' BUTTON BELOW, YOU SHOULD BE TAKEN TO A "THANK YOU FOR YOUR REGISTRATION" PAGE. REGISTRATION IS NOT COMPLETE UNTIL YOU ARE TAKEN TO THE "THANK YOU" PAGE If you are not taken to the "Thank You" page please review all required fields above.

AFTER YOU CLICK THE 'SUBMIT' BUTTON BELOW, YOU SHOULD BE TAKEN TO A "THANK YOU FOR YOUR REGISTRATION" PAGE.

REGISTRATION IS NOT COMPLETE UNTIL YOU ARE TAKEN TO THE "THANK YOU" PAGE

If you are not taken to the "Thank You" page please review all required fields above.