Conversational English Kids Class • WPC Bull Creek

First Name *

Tip: Kid's First Name

Last Name *

Tip: Kid's Last Name

Date of Birth *

School Year *

Gender *

Languages spoken other than English

Does your child have any serious medical conditions or allergies that we should know about? *

Yes

No

Please give details *

Parent's First Name *

Parent's Last Name *

Parent's Phone Number *

Email Address *

Tip: Parent's email

Alternative Emergency Contact Name *

Alternative Emergency Contact Phone Number *

Publish Photo *

Yes

No

Tip: By selecting "YES", you give consent for your child to be included in any group photograph which may be published in printed or online publications of Westminster Presbyterian Church Bull Creek

By submitting this form I agree that all the details supplied are accurate and give my permission to my child to participate in WPC Bull Creek Conversational English Classes *

Yes

Registration for Kids Attending