Matthew Whaley 2018 Christmas Party

Registration for Matthew Whaley Christmas Party Club

Fields with a star are required fields. Fields will appear red when not correctly filled in. Please review your entries before submission.

After you press “Submit” you will see a confirmation message immediately and receive a confirmation email if all required information is submitted. If you do not see the confirmation message on the site, scroll down to review the form and complete the fields highlighted in red. Then sign and submit the competed form.

If you continue to have difficulties, call or email the club representative listed below. Thank you!

Matthew Whaley Christmas Party

Time: Immediately after school until 5:15pm
Date: Wednesday December 12, 2018
Place: Matthew Whaley Elementary School - Gymnasium
Who can attend? All boys and girls in grades K-5, regardless of religious
background. Parents are also welcome to attend with their child anytime.
Sponsored by: First Baptist of Williamsburg and CEF of Virginia
Contact for Information: John Williams; 757-345-5269

Child Name *

Birthday - (e.g.; 10/23/2018) *

Age *

Gender *

Male

Female

Grade Level (K, 1, 2, 3, 4, 5) *

Homeroom Teacher *

Child Allergies *

Yes

No

If yes, please list allergies (peanuts, chocolate, etc.)

Is parent in military? *

Yes

No

Does your child attend church?

Yes

No

Name of church attending

Parent/Guardian Name #1 *

Parent/Guardian Phone #1 *

Parent/Guardian Email #1 *

Parent/Guardian Name #2 *

Parent/Guardian Phone #2 *

Parent/Guardian Email #2 *

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Select how your child will get home on club day. *

My child will be picked up

My child will transition to the school’s extended day/after-school program.

These people (include phone numbers) are allowed to pick up my child if I’m not able to:

Name *

Phone Number *

Name

Phone Number

I give my permission for my above-named child to attend the 2018 Blayton Christmas Party. *

Yes

I understand it is my responsibility to pick up my child immediately when the club ends. *

Yes

I will send a note to the school requesting my child stay after school to attend the Christmas Party. *

Yes

I give permission for photographs/videos of my child to be used in club and ministry promotions.

Yes

I give permission for my child to continue attending the GNC after the Christmas Party; when the GNC resumes in 2019.

Yes

Parent/Guardian Signature: Enter your signature in the box using your finger on the touch-pad/track-pad or with your mouse's cursor in the box. *

• Draw It
• Type It
• Clear

Date

Reference Number

reCAPTCHA

Δ