Joyland Registration Form

Please fill out this form and click submit. If you are more comfortable completing a paper form, those are available at the children's check-in area at BRCC.

Primary Staff Contact: Jill Bardonner, Children's Ministry Directory, jbardonner@brookvilleroad.cc

Child #1 - Name

*

Child #1 - Date of Birth

*

Child #1 - Grade

Child #1 - Gender

*

Please select one option.

Male Female

Child #1 - Special Needs/Allergies

Child #2 - Name

Child #2 - Date of Birth

Child #2 - Grade

Child #2 - Gender

Please select one option.

Male Female

Child #2 - Special Needs/Allergies

Child #3 - Name

Child #3 - Date of Birth

Child #3 - Grade

Child #3 - Gender

Please select one option.

Male Female

Child #3 - Special Needs/Allergies

Child #4 - Name

Child #4 - Date of Birth

Child #4 - Grade

Child #4 - Gender

Please select one option.

Male Female

Child #4 - Special Needs/Allergies

Parent(s) Name(s)

*

Mother's Email Address

This address will receive a confirmation email

Mother's Cell Phone

Father's Email Address

Father's Cell Phone

Address

Would you like to receive the weekly e Newsletter?

*

Please select one option.

Yes No

Our church uses photos and videos of our guests for communication purposes. By checking one of the boxes below, you either will deny or allow permission for the church to use your and your child’s image for these purposes.

*

Please select all that apply.

I DO GIVE Brookville Road Community Church my permission to use video and/or photos under these terms. I DO NOT GIVE Brookville Road Community Church my permission to use video and/or photos under these terms.

Description

Please fill out this form and click submit. If you are more comfortable completing a paper form, those are available at the children's check-in area at BRCC.

Primary Staff Contact: Jill Bardonner, Children's Ministry Directory, jbardonner@brookvilleroad.cc

Please Fix the Following

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