Child Registration

Registration Form

* Indicates required field

Family's Name *

Last Name of Family

Child's Name / Birthdate / Grade *

One box per child.

Child's Name / Birthdate / Grade *

School *

Allergies/Health Concerns *

Please list all per child. Example: Fred: Milk Allergy Suzie: None

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent's Name (1) *

Parent's Number (1) *

Parent's Name or Emergency Contact (2) *

Parent's Number (2) *

Parent's Email (1) *

Parent's E-mail (2) *

Children's Ministries *

Vacation Bible School (VBS) Peanut/Cashew Catechism Middle School Ministries (MSM) GEMS Cadets

How did you hear about CCRC? *

Does Coopersville CRC have your permission to use photos of your child on their website, facebook, and/or paper publications? *

Yes No

GEMS & Cadets we sometimes travel. Does your child have permission to ride with a leader or another parent that is transporting? *

Yes No

Would you like more information about CCRC? *

Yes! Please! No.Thank You!

Submit

Visit us on FACEBOOK!

207 Henry St,
Coopersville, MI

616-997-8684

coopersvillecrc@gmail.com