REGISTRATION FORM
Please complete one form for each child.
Child Name
*
FIRST
LAST
Additional Child Information
*
Parent/Guardian Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Emergency Contact
*
FIRST
LAST
Relationship to Child
*
Phone Number
*
Please enter a valid phone number.
IN CASE OF AN EMERGENCY (when a parent, guardian, or emergency contact is unable to be reached), I, the signee, give my permission, by signing this form, to The Crossroads Community Church, its staff and volunteers, to secure treatment for my child by contacting the local authorities or medical professionals.
*
Please list any medications, allergies, special instructions, etc., that staff should be aware of. If none, enter "N/A".
*
ONE WAY YEARLY FAMILY DUES
1 child: $20
2 children: $30
3 or more children: $40
Payment Method (Due at first event)
*
Check *Made payable to: The Crossroads Community Church*
Cash
The One Way Club has a closed Facebook group for parents and staff to stay connected. Pictures and videos are posted here of children, staff, and volunteers in attendance including live videos. We do not share this media publicly. Please initial here to acknowledge this.
*
Submit
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