Register for Time Lab VBS, June 24-29!

Note: Parents must complete a Medical Information & Permission Slip
for each child attending a CMBC activity.

 

Beakers

 

Parent/Guardian Name(s):
Home Address:
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Email:*
Home Phone:
Cell Phone:
Emergency Contact Name:
Emergency Contact Phone:
List the names of the people you have given permission to pick up your children. Include parent/guardian names:
Child's Name:
Grade Completed:
OR Age, if not in grade school:
Is there a special friend your child would like to be grouped with?
Special needs, allergies, other notes:
Child's Name:
Grade Completed:
OR Age, if not in grade school:
Is there a special friend your child would like to be grouped with?
Special needs, allergies, other notes:
Child's Name:
Grade Completed:
OR Age, if not in grade school:
Is there a special friend your child would like to be grouped with?
Special needs, allergies, other notes: