CKC Family Service Event

Family Service Event Registration
Events You Want to Register For*

April - Practice LoveMay- Practice AwarenessJune - Practice Gratitude
How Many Total People Will Be Attending the March Service Event?
How Many Total People Will Be Attending the April Service Event?
How Many Total People Will Be Attending the May Service Event?
How Many Total People Will Be Attending the June Service Event?
Would you be interested in reminders about future FSE?

YesNo
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number (This phone number will remain private and will not be shared outside our organization. We will only contact you if you have signed up for one of our programs and we have not received replied confirmation back via email.)*

Area CodePhone Number
Additional Attendees' First Names*
Please indicate adult or child
Where did you hear about CKC?*

SearchTeacherFamily/FriendNewsletterFacebookOther
Terms of Agreement

Please see all terms of agreement regarding Medical Release, Liability, Photograph/Video/Digital Release, Assumption of Risk and Indemnity Agreement, Drop Off/Pick Up Policy, and Refund Policy by clicking here: www.campkindnesscounts.org/release
Initial Here*
I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I HAVE READ AND FULLY UNDERSTAND THIS RELEASE AND INFORMED CONSENT FORM, AND I SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.
Parent's or Legal Guardian's First Name*

First NameLast Name
Family Member Names:
Today's Date*

MonthDayYear
Date
Should be Empty:

Family Service Event Registration