Southminster United Church
6801 Hagar Avenue
Niagara Falls Ontario
L2G 5M5
(905) 354-2125
info@southminsterunited.com
Contact Reverend Sherry Fugard
 

Southminster United Church

 KIDS KITCHEN CLUB - 2017

Registration Form

Name                   

Date of Birth         

Age(children only)

Parent/Guardian  

Email                   

Address               

Phone                  

Cell                     

KIDS KITCHEN CLUB (age 6 - 12)

Cost: $15.00 for 4 sessions, cheque or cash

Emergency Contact Person(s)

Emergency Contact 1 
Relation to Child 
Home Phone   Cell 

Emergency Contact 2 
Relation to Child 
Home Phone    Cell 


Food Allergies    YES     NO

List Allergies 


Medical Concerns   YES      NO

Explain 

Health Card # 

Doctor   

Doctor Phone 


Person(s) Who May Pick Up Child





Any Additional Comments