#CornerstoneKids EPIC After-School Program
EPIC Registration
Sign in to Google to save your progress. Learn more
Email *
EPIC Afterschool program at Cornerstone Community Church
We welcome everyone from K-5! Kids at Fredericktown Elementary can meet #CornerstoneKids staff in the commons after school (or may be dropped off at the back of CCC by 4pm.) Then they will walk or ride on a wagon over to the back door of CCC (we also use the LifeWise bus on bad weather days). Once there, we break for bathroom use and to wash hands!  From there, we go upstairs to THE LAB. Once there, we eat a snack, sing songs, play with puppets, listen to a Bible story (and sometimes act it out). We play games, do trivia and hang out until 5pm. At 5pm, parents are waiting outside of THE LAB (or pick up outside if the weather permits). Adults who help with the EPIC program are: Kalvari, Kurt and Annabelle Kershner, Mark Maxwell, Ben Blevins, Kristine Wilson-Lee, Kristine Lindeman and Tammy Partington.

We will begin on Wednesday Oct 2nd this year!
Student First and Last Name *
Student Birth Date *
MM
/
DD
/
YYYY
Grade for 2024-2025 school year *
Teacher Last Name *
Parent/Guardian First and Last Names *
Parent Phone number *
How will the student arrive at CCC? *
*If your child meets in the Commons, answer this question. If they will be dropped off, please SKIP to next questions.

What is your child's normal way of going home (in case they forget to meet in the Commons and we need to locate them). Please include a BUS NUMBER if necessary.
Who will pick up your child promptly at 5pm? *
We serve snacks! Does your child have any food allergies or other health concerns that we need to be aware of? *
Almost every week that the weather is nice enough, your child chooses to ride the wagon (pulled by a car driven by Mr. Kurt, and Kalvari will always ride in the wagon with them) or walk (an adult always walks with them). Do you give consent for your child to ride in the wagon?
*On the weeks that we do not have the wagon available, everyone walks with an adult.
Clear selection
Occasionally, when the weather is too bad to walk, we will ride the LifeWise bus to CCC. Do you consent for your child to ride the LW bus? (There will always be adult chaperones on the bus).
Clear selection
I consent to the photography or video of my student while at Cornerstone Community Church, for promotional purposes. *
Please note: If your child will NOT be joining us for EPIC on a particular week, PLEASE (please! Please!) text Kalvari Kershner (740-501-7873) directly to let us know. We have around 30 kids to gather each week, and we do not want to be looking for a child who is not planning to join us that week. Thank you!!
Comments or Questions
By typing YOUR NAME below, you are agreeing that everything on this form is correct, and this will serve as your signature. *
Today’s Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms