Sunday-Thursday 6:15p-8:30p Registration Fee $10 per child T-Shirts Available Separately—

Please contact the church office at 218-4646 or office@christclc.org

Come join us and feel how life changing being rescued by Jesus can be!

Child’s name (one child per form): Grade Entering: _

Gender: _ Date of birth: _

Allergies: Other medical conditions:

Name of a friend child would like to be with:

Parent name: Phone number:

Home Church: Email address: _

Address: City: State: Zip:

EMERGENCY CONTACT (other than parent listed above):

Name: Relationship: Phone: _

Photo authorization: I do hereby assign all rights, privileges and materials for reproduction to Christ Community Lutheran Church (CCLC), for any or all photographs taken of me by CCLC or its recognized agents. I further grant CCLC the right to use my name and likeness in its publications and/or website and related products and services.

Signature: _

Church use only:

Entered: Date: Paid: Date: