Christian Character School

Christian Character School

Fill out the form carefully for registration
Student Name*

Last NameFrist Name
Guardian Name *

First NameLast Name
Birth Date

MonthDayYear
Gender*
Age *
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Phone Number*
Emergency Contact *

Name Phone Number
Will Your Child Need Transportation?*

No, I will be responsible for picking up, and dropping my child off.Yes, my child will need transportation.
Allergies*
Please list any and all allergies
I, grant permission for my child, to participate in The Church of God Youth Christian Character Development & Leadership Initiative and all planned activities associated with this event. I also grant the Church of God permission to use photo or video taken at the program in publications, news releases, online, & in other communications related to the program. I take sole responsibility for my child’s participation in this event and agree not to hold The Church of God liable or responsible for injuries, incidents, and/or medical expenses that might arise during my child’s participation in this program.
Additional Comments
Signature*

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