Donnels Creek Church of the Brethren
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Register Me for 4-Day Bible Club
Child's Name:
Gender:
Birthdate(dd/mm/yyyy):
Grade:
Address:
City:
Zip:
Parents/Guardian:
Home Phone:
Cell Phone:
Work Phone:
Email:
Emergency Contact:
Relationship to Child:
Phone:
Name of Home Church:
List:
Explain:
Food Allergies:
Medical Concerns:
Free to all 1st - 6th Graders
Tuesday thru Friday - 6:30 - 8:30 pm
June 19th - 22nd
Male
Female
Yes
No
Yes
No