Refuel Registration (Children 3 years through 6th Grade)
Refuel Midweek Program - Wednesdays from 6:00-7:00pm (optional supper - $3 per person - from 5:15-5:50pm)
Peace Lutheran Church - 2720 28th St. Columbus, NE 68601
Contact us at (402) 564-8311 or sholt@aliveinpeace.org
Child's Name *
Your answer
Child's Grade *
Your answer
Parents/Guardians *
Your answer
Email *
Your answer
Home Address *
Your answer
Phone Number *
Your answer
Does your child have any allergies/medical conditions? *
Your answer
Do you plan to join us for supper (before Refuel from 5:15-5:50pm - $3 per person)? *
Required
If you plan to join us for supper, how many people will be eating?
Your answer
Will your family need childcare (children under 3 years of age) during Refuel? *
Required
Name & Age of Child Needing Childcare
Your answer
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