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C A D E T S - Registration Form
New Life Church Boys Club
2nd to 8th Grade
1st & 3rd Wed of the month (Sept - April)
7:00 - 9:00 pm
2009/10 Calendar
Contact: Howard Buikema at bhome1@sbcglobal.net.
Click here to download the 2009/10 Registration Form.
You can print it, fill it out, and place in Howard Buikema's mail slot or
bring it with to the next scheduled meeting.
If you prefer, you can register online be completing the information below.
Your Name: *
E-mail Addr: *
Mother's Information
Mother's Name:
Address:
City: Zip:
Home Phone: Cell Phone:
E-mail Address:
Fathers' Information
Father's Name:
Address:
City: Zip:
Home Phone: Cell Phone:
E-mail Address:
Secondary Emergency Contact
Name:
Home Phone: Cell Phone:
First Aid/Emergency Medical Information (Required) *
I hereby authorize and give consent to the staff of New Life Church to
administer any necessary first aid and/or seek any emergency care for
my child while he is in their care.
Enter adult's name giving consent:
Medical Information
Family Doctor:
Phone Number:
Insurance Company:
Insurance Group #:
Insurance Susbcriber #:
Child #1 - Required *
Child Name:
Birthdy(MM/DD/YY):
Allergies/Other Medical Condition:
Date of Last Tetanus Shot:
Child #2
Child Name:
Birthdy(MM/DD/YY):
Allergies/Other Medical Condition:
Date of Last Tetanus Shot:
Child #3
Child Name:
Birthdy(MM/DD/YY):
Allergies/Other Medical Condition:
Date of Last Tetanus Shot:
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