Summer Kid’s Reading Club Registration Form

Bethany United Church of Christ
Featuring the “Bethany Bee”

Thursdays in July (5th, 12th, 19th, 26th)

9:30-11:30 a.m.

For kids who have completed K-5th grade by the end of this school year

Books, Games, Crafts and More with a focus for kids to “Bee” A Good Friend, “Bee” ready to learn, “Bee” helpful, and to “Bee” the best YOU that You can be!”

Please complete and return bottom portion of this form with $5 registration fee per child by June 25th.  Pre-registration is required.

Child’s Name:  ____________________________________   Date of Birth:  _____________

Grade completed at the end of 2017/18 school year: ________

Allergy information:  ___________________________________________________

Name of person/s permitted to pick up your child:  ______________________________

Parent or Guardian’s Name:  ______________________________________________

Emergency Contact:  Name: __________________________ phone: _____________________

Address: ______________________________________________________________

Email: _________________________________   Phone number:  _____________________________ _

Is there anything you want us to know about your child/children that will help us serve them better during their time with us?  __________________________________________________________

I give permission for my child to participate in the Bethany Summer Kids’ Reading Club:

Signature required: _______________________________________


Please mail this form or drop by with $5 per child payment:    Bethany U.C.C., 600 West Market Street, Bethlehem PA 18018 (corner of 5th Avenue and Market Street).   Office open weekday mornings from 9-1.   For more information email or call 610-868-4441.

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