Sign-up for Eben Ezer Kids Klub this summer!
Event Timing: July 11 to 15, 2022 from 6.30pm to 8.30pm.
Event Address: 483 McNaughton Ave E, Chatham, ON (both school and church property)
If you have any questions please contact us at ebenezerkidsklub@gmail.com

The form will automatically be emailed to you. If you do not see it, please check your spam folder.
Влезте в Google, за да запазите отговора си. Научете повече
Имейл адрес *
Contact Name (First Name and Last Name) *
Contact Primary Phone Number *
Contact Alternate Phone Number
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relationship to Child(ren): *
Any secondary emergency contact names and phone numbers:  
Please tell us about the child(ren) you would like to sign up.
Child 1 Name: *
Child 1 Age: *
Child 1 Gender: *
Child 1 Allergies or other considerations: *
Child 2 Name:
Child 2 Age:
Child 2 Gender:
Child 2 Allergies or other considerations:
Child 3 Name:
Child 3 Age:
Child 3 Gender:
Child 3 Allergies or other considerations:
Child 4 Name:
Child 4 Age:
Child 4 Gender:
Child 4 Allergies or other considerations:
Child 5 Name:
Child 5 Age:
Child 5 Gender:
Child 5 Allergies or other considerations:
More children? No problem! Please use the text box below:
Which evenings is (are) your child(ren) attending? If you need to change it later, no worries, just contact us by e-mail or let us know during the event.  On Friday, July 15 at 8.00 pm, families and friends can join us for a brief program to see what the kids have learned! *
Задължително
Pick up Authorization: Who will be picking your child(ren) up?
Do(es) your child(ren) regularly attend a church? If so, please list the church:
Would you like to receive occasional email updates from us regarding next year's Kids Klub and other church community events?
Изчистване на избора
I authorize the Eben-Ezer volunteers in the event of an accident or illness affecting the above named child(ren) to authorize on my behalf all medical procedures including admission to hospital and necessary treatment therein, as deemed essential for the care and well-being of my child(ren). Such action is to be taken only when the immediate contact with the parent or emergency contact person listed cannot be made. I will not hold Eben-Ezer Canadian Reformed Church of Chatham responsible for any injury my child(ren) may incur while in their care, or for any lost or stolen items my child(ren) brings to Kids Camp with them. *
Do you have any prayer requests you would like to share? If you have some later, feel free to email them to us at ebenezerkidsklub@gmail.com or prayerrequesteecrc@gmail.com.
Do you have any other questions or comments you would like to share?
Копие от отговорите ви ще бъде изпратено до посочения от вас имейл адрес.
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