MVP

Child's Information

Child's Name:

Gender: - Choose One - Male Female

Birthday: - Choose Month - January February March April May June July August September October November December

Arts/Athletics: - Choose One - Baseball Basketball Football Soccer Ballet/Dance
Note: Our Outdoor Adventure and Art sections are now full.

Parent/Guardian Information

Parent or Guardian:

Address:

Contact:

Emergency Information

Special Needs:

Emergency Contact:

Authorized Pickup:

Everything Else

Are you a member of North Cincinnati Community Church?
Yes No

Do you attend Church?
Yes No

If so, where?

May we have permission to photograph your child?
Yes No

May we use your child's photograph in Church publications?
Yes No

Comments:

Waiver and Release
I have read and agree to the terms and conditions.

Permission for Transportation from NCCC to Cottell Park
I have read and agree to the terms and conditions.