Party Club Sign-up
Student Info
Student Name
*
First Name
Last Name
Age
*
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Grade in School
*
School Attending
*
Phone Number
*
Please enter a valid phone number.
Parent Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Party Club Your Child Will Be Attending
*
March 15th - 3:00-4:30 pm @ Santiam Christian School Cafeteria - 7220 NE Arnold Ave, Adair Village
March 19th - 3:00-5:00 pm @ New Life Fellowship - 1412 Applegate St, Philomath
March 19th - 6:00-7:30 pm @ The Gathering - 5050 NE Elliott Cir, Corvallis
March 21st - 3:15-5:00 pm @ First Baptist Church of Corvallis - 125 NW 10th St, Corvallis
Who will be doing pick-up/drop-off for your child?
*
Guardian's Full Name
*
"By signing this form, I, the parent (or guardian), do hereby give permission for my child to attend and participate in a Party Club. I release Child Evangelism Fellowship and the facilities used from liability for any injuries or sickness incurred as a result of my child’s participation in a Party Club. I hereby assign and grant to Child Evangelism Fellowship full use of all photographs of the above named child, without reservation or limitation, including use of photographs for promotional purposes. Names will be changed for privacy.”
Guardian's Signature
*
Any Additional Notes/Food Allergies
Submit
Should be Empty: