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
*
Mailing Address
Mailing Address Line 2
City
State / Province
Postal / Zip Code
Party Club Your Child Will Be Attending
*
Dec 6th - 1:00-3:00 pm @ Alsea Christian Fellowship - 18080 Alsea Hwy, Alsea
Dec 7th - 1:00-3:00 pm @ Philomath Middle School - 2021 Chapel Dr. Philomath
Dec 17th - 3:00-5:00 pm @ The Gathering - 5050 NE Elliott Cir, 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: