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About
Youth
Kids
Grow
Mission
Calendar
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Contact
Home
About
Youth
Kids
Grow
Mission
Calendar
Media
Contact
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!
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Indicates required field
Name of Child
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Date of Birth
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Grade Completed
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Age
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Name of Child
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Date of Birth (mm/dd/yy)
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Grade Completed
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Age
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Name of Child
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Date of Birth (mm/dd/yy)
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Grade Completed
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Age
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Name of Child
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Date of Birth (mm/dd/yy)
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Grade Completed
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Age
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Parent or Guardian Name
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First
Last
Address
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Home Phone
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Email
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Cell Phone
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Special Needs / Allergies / Other Concerns
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Emergency Contact Name & Number
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Home Church (If you attend a local church)
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Electronic Signature
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Typing your name here is an electronic signature for Coudersport Alliance Church VBS registration
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