Family Life Night 2024-2025

Please fill out this form and click submit to register your child for the current year of Family Life Night.
For more information about our church or to see other ministries we offer, please go to www.cccrichland.org.

Parent/Guardian Information

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

How did you hear about our Family Life Night Program?

Please select all that apply.

at CCC Invited by a friend CCC website Facebook Sign/Poster Other

Child's Information

Child's Name

Gender

Please select one option.

Female Male

Child must be at least 3 years old and potty trained. Please enter Grade level as of September 1st of current school year.

Birthdate

Grade (2024-25)

Please select one option.

Preschool PreK K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

What size shirt does your child need?

Please select all that apply.

Youth Small Youth Medium Youth Large

Known Allergies or Medical Conditions

Emergency Contact

Emergency Contact Phone Number

I give permission for basic first aid to be administered to my child in the event of an injury/incident. It is my understanding that parents will be notified of any and all injuries and contacted immediately in an emergency situation.

Please select one option.

Yes No

E-mail is an acceptable method to contact me when CCC Family Life Night events are postponed or cancelled.

Please select one option.

Yes No

From time to time, CCC Family Life Night produces videos and pictorial slideshows for promotion of the club that may, or may not be used on the internet. I give permission for my child to be photographed or videotaped for use in such promotions.

Please select one option.

Yes No

Family Life Night 2024-2025

Description

Please Fix the Following