Extending God's Grace in the community of Chippewa Lake, OH
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Anchor Club Registration
Anchor Club Registration Form
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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