The Christmas Picture club

Event Date Friday, December 19th, 2025 @ 6:30pm to 7:45pm

Ages 5-11 years

Registration Deadline Thursday December 11,2025

Please complete all sections of this form. All information will remain confidential.

Child's Information

First Name

Last Name

Date of Birth

Gender

Home Address

Emergency Contact (Other than Parent/Guardian)

Name

Relationship to Child

Phone Number

Medical Information

Food Allergies

Medical Conditions

Medications

Parent/Guardian Information

First Name

Last Name

Relationship to Child

Phone Number

Email Address

Permissions & Agreements

I give permission for my child to be photographed for program purposes
YesNo
Can we email you about future children’s events?
YesNo
Your contact info will only be used for church events.

Signature

Parent/Guardian Signature

Date