FORMULARIO DE INSCRIPCIÓN REGISTRATION FORM THE LIFE

THE LIFE CHURCH – 1 Old Westbury, Old Westbury, NY 11568
Tel 516 333 3355
www.thelifeny.org
FORMULARIO DE INSCRIPCIÓN
REGISTRATION FORM
Nombre (Name) __________________________________________________________
Age ____________
Dirección (Address) _________________________________________________________________________
Ciudad (City) ________________________________ Estado (State) _________________ ZIP _____________
Teléfonos (Phone) ______________________________________
Celular (Cell) _____________________
CE (Email) _____________________________________________
Grado escolar completado (Grade completed) ___________________________________________________
Contactos en emergencia (Emergency contacts) __________________________________________________
_________________________________________________________________________________________
Madre (Mother) ___________________________________________________________________________
Padre (Father) _____________________________________________________________________________
Otros (Other) _____________________________________________________________________________
_________________________________________________________________________________________
Alergias/Problemas médicos (Allergies/Medical Problems) ________________________________________
_________________________________________________________________________________________
Iglesia (Home Church) ______________________________________________________________________
Nombre de amigo con quien su hijo(a) quisiera estar: ____________________________________________
(Name special friend your child would like to be with): ___________________________________________
Firma Madre/Padre o Apoderado ____________________________________________
Por favor mande por correo el Formulario de Inscripción completado a:
Please mail the completed Registration Form to:
Att: Paulina Janssen, Ministerio Hispánico
THE LIFE Church, 1 Old Westbury Rd.,
Old Westbury, NY 11568