Southlands Community Church

KidsQuest

KidsQuest Registration
Child's Full Name:		Age: Male Female
Street Address:
City: Postal Code:		Telephone (with area code):
Medical Health Number
Please list any health/medical conditions (i.e. asthma, allergies, hyperactivity, etc.):
Parent/Guardian's Full Name:
Home Phone:	Business Phone:	Cell Phone:
Emergency Contact Name:
Church Affiliation (if any):
Please select camp:
Week 1 - July 5-9 Week 2 - July 12-16 Week 3 - July 19-23 Week 4 - July 26-30 Week 5 --August 3-6 Week 6 - August 9-13

85 Keslar Rd | Winnipeg, MB R3T 6A5 | Ph: 204.946.9160 | Fax: 204.946.9165 | info@southlandschurch.com