KidzClub - COUDERSPORT ALLIANCE CHURCH

Kidz Club is for children grades K-5

Meets Tuesday Nights from 6:15 - 7:30 pm
Fall Session: September 12 through November 14

Register Today!

* Indicates required field

Name of Child *

Date of Birth *

Grade Completed *

Age *

Name of Child *

Date of Birth (mm/dd/yy) *

Grade Completed *

Age *

Name of Child *

Date of Birth (mm/dd/yy) *

Grade Completed *

Age *

Name of Child *

Date of Birth (mm/dd/yy) *

Grade Completed *

Age *

Parent or Guardian Name *

First

Last

Address *

Home Phone *

Email *

Cell Phone *

Special Needs / Allergies / Other Concerns *

Emergency Contact Name & Number *

Home Church (If you attend a local church) *

Electronic Signature *

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