Kids Games 2010
August 9-13, 6pm-9pm
Salvation Army Chilliwack Community Church.
46420 Brooks Avenue, Chilliwack, BC V2P 1C5
Ph.(604) 792-0311 Fax Ph. (604)792-0316 Email: [email protected]
Cost: $25 per child before Aug.6, $35 at the door
Child’s First Name
Age
Going into Grade (1-6)
Address
BC Medical #:________________________
Parent /Guardian Name(s)
Home phone
Work
E-mail
Last Name
Male
City
Female
Postal Code
Cell
Do you attend church regularly (Circle one) Yes No
If Yes, which one:
Pastor: ___________________
Where did you hear about Kids Games? ____________________________________________
Emergency Contact
Relationship to child
Phone number
Allergies/Health Concerns
Please list any allergies or health concerns for your child:
Is there anything else we should know about your child that will help us care for them?
Choice of Track preference: (please number first, second, and third preferences.)
____ Soccer
____ Cheer Club (limited to 25)
____ Karate (limited to 20)
Consent Statement
I consent to the participation of the above named child in Kids Games. I fully understand the sports
nature of this event and verify that the child is physically fit to participate. In the event of an
accident I authorize Kids Games staff to take action as they deem necessary to ensure the safety and
well-being of my child. I will not hold Kids Games Chilliwack or any of its representatives liable
for any accidents that may occur during this Kids Games. I authorize The Salvation Army
Chilliwack Community Church to use photos taken at Kids Games of my child for promotional
literature only.
Parent /Guardian signature
Date: _________________
Office use only: (Total Fee: $25 before Aug. 6, 2010, $35 at the door)
Scholarship? Y N Amount paid:
Balance Due: _______________
Date Paid:_____________________
Staff Signature:
Kids Games Registration Form 2010