Anchor Club Registration

Child(ren)’s info

Student’s Name

Age

Birthday

Grade

Add Another Child Remove Child

Mother’s Name

Phone Number

Address

City

State

Zip

Father’s Name

Phone Number

Address

City

State

Zip

Emergency Contact Name/Phone/Relationship

In case of medical emergency, the Program’s personnel are authorized to take my child to the nearest hospital for emergency care.

Yes

No

Are there any behavioral, dietary, allergies, or medical concerns we should know about that may affect the student’s participation?

Parents’ Church

Parent Commitment – We encourage the support of family members. Please consider volunteering. Check any areas of interest. Thank you!

Bring a dessert

Be a table parent

Help in one of the 4 program areas (check and indicate your area of interest below)

Check interest:

Recreation

Worship Arts

Meal Time

Bible study

Photo Waiver

I give permission for my child/children to be photographed/videotaped and shared on CrossPointe Community Church approved social media and websites.

I DO NOT give permission for my child/children to be photographed/videotaped and shared on CrossPointe Community Church approved social media and websites.

Registration Fees: $3 per session per child

Questions? Please contact Sheri Back at (330) 603-3060 or backoncall@gmail.com.

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Anchor Club Registration

Child(ren)’s info

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