Word of Life Club Registration 2017-18
Word of Life Clubs is open to children in K4-5th Grades
Please plan for your student to wear sneakers/gym shoes EVERY Wednesday
Mother Last Name
Your answer
Mother First Name
Your answer
Address
Your answer
Mother Email Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Father Last Name
Your answer
Father First Name
Your answer
Address
Your answer
Father Email Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Do you attend church regularly?
If yes, where?
Your answer
Child #1 Last Name
Your answer
Child #1 First Name
Your answer
Grade
Your answer
Age
Your answer
Allergies or special needs?
If yes, explain:
Your answer
Quiet Time Book
Child #2 Last Name
Your answer
Child #2 First Name
Your answer
Grade
Your answer
Age
Your answer
Allergies or special needs?
If yes, explain:
Your answer
Quiet Time Book
Child #3 Last Name
Your answer
Child #3 First Name
Your answer
Grade
Your answer
Age
Your answer
Allergies or special needs?
If yes, explain:
Your answer
Quiet Time Book
Club Fees (Scholarships available, ask for details)
First child $30
Second child $55
Third child $80
Total Cost
Your answer
Submit
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