Club 345 Registration
STAND FREE
"Christ has broken our enslavement to sin and set us free! So stand as free people, and never be slaves again!"
— Galatians 5:1

Club 345 is a one day activity for 3rd, 4th, & 5th Graders!

Join your friends for a day of fun and faith, and meet some great new people from around South Carolina!

Please make sure you have at least one adult per each 6 youth. We will also have an adult leaders of youth seminar during this time, so please make sure to send a leader to this and take this into account when getting adult volunteers!

***Please be certain to fill out the LCY Emergency Medical Information & Permission form!***

http://scsynod.us/lcymedicalinfo

This is a link to this page for your friends:
Individual Registration – http://scsynod.us/lcyclub345
Group Registration – http://scsynod.us/lcyclub345group

WHEN
December 3, 2016
Registration begins at 10am
Event ends at 3pm

WHERE
Mt. Hermon Lutheran Church
3011 Leaphart Rd
West Columbia, SC 29169


WHO CAN COME?
For 3rd, 4th & 5th Graders
Please send 1 Adult per 5-6 youth, and remember that you can send leaders to our leaders of youth seminar.

WHAT IS THE COST?
$15 per registrant. This covers lunch, a t-shirt, and incidental costs. Because many congregations supplement this cost, we prefer that payment for the retreat be arranged through the congregation. If you're paying individually, please contact eric@scsynod.com so Pastor Eric knows to be on the lookout for your check.

Unless indicated otherwise in the comments, completion of this registration grants photo release rights for social media, annual yearbook, slideshows, and other forms of printed and digital media.

Completion of this registration also grants permission for the registrant to receive emergency medical care. Please be certain to complete the Emergency Health Form, which is in a separate survey, so that we can have accurate information in the event of an emergency during which a parent or guardian cannot be contacted.

We can't wait to see you there!

Last Name
Your answer
First Name
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Grade
Name of Parent(s) / Guardian(s)
If you're an adult registrant, please just put your own name.
Your answer
Home Congregation (Name, City)
Example: Cedar Grove, Leesville
Your answer
Home Address — Street
Your answer
Home Address — City, State
Your answer
Home Address — Zip Code
Your answer
Primary Phone — Adult
Preferred number to reach an adult.
Your answer
Primary Phone — Youth
Preferred number to reach a youth registrant.
Your answer
Email — Adult
Preferred email address to reach an adult.
Your answer
Email — Youth
Preferred email address to reach the youth registrant.
Your answer
Name of your congregation's youth contact
Your answer
Youth Contact Email Address
Your answer
T-Shirt Size
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