CSB (Christian Service Brigade) Registration
Friday Nights at 7-8:45pm. Begins September 12th
Child's Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Age
*
Grade entering in Fall 2025
*
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Guardian's Name
*
First Name
Last Name
Additional Parent or Guardian's Name
First Name
Last Name
Email
*
example@example.com
Secondary Email
example@example.com
Emergency Contact Number
*
-
Area Code
Phone Number
Additional Contact Number
-
Area Code
Phone Number
Does your child have allergies or any special health concerns?
If YES, please list any/all allergies/concerns
What church do you attend?
*
Additional information/comments that Stockade Leadership should be made aware
Submit
Should be Empty: