PowerPlay Reg - Putnam City Baptist Church


Pre-Registration Form

Name
Phone
Address
Apt
City
State
Zip
Age
Birthday	(mm/dd/yyyy)
Grade just completed (1 - 5)	Completed K
If you have a friend you want to be in the same group with, place his/her name here.
Parent/Guardian
Phone	(home) (work or mobile)
Email
Medical Release Form info	All AGES!!→ Be sure to read and sign the POWERPLAY Medical Release form. You can print out the form by clicking here→. A child may not participate without a signed release form on file.
	Do you attend Putnam City Baptist Church on Sundays?
	Yes No
	Do you attend another church weekly?
	yes Where?no
	How did you learn about POWERPLAY?
	At PCBC
	From a PCBC Member Friend Yard Sign
	Flyer Web Site Newspaper Radio

Pre-Registration Form