Zera Bible Club Registration Form

1. Participant Information

Full Name of Child:

Gender

Date of Birth (DD/MM/YYYY): (copy)

Age

Grade/Class

School Name

2. Parent/Guardian Information

Full Name of Parent/Guardian:

Phone Number

Phone Number (Primary):

Phone Number

Phone Number (Alternate):

Email Address

☐ from Emergency

Home Location/Address:

Preferred Contact Method: ☐ Call ☐ WhatsApp ☐ Email

3. Emergency Contact (If different from parent/guardian)

4. Health & Special Needs

Does the child have any learning or special support needs? ☐ Yes ☐ No If yes, please explain:

5. How did you hear about us?

6. Consent & Agreement

Yes, I agree

I consent to my child participating in Zera Bible Club programs and activities.

I understand that Zera Bible Club will communicate with me via the contact methods I have provided.

I give permission for photos/videos of my child taken during the program to be used for promotional purposes.

I confirm that all the information provided is accurate.