Club 56 Registration Form

Club 56 meets on Sundays from 11:45am-1:15pm. Orientation Party Potluck will be held in the Fellowship Hall for students and parents on September 18. Please fill out one form per student.

Student Name:(required)
Grade:(required)
Gender: (required)
Age:(required)
Birth Date:(required)
Favorite Lunch:(required)
Student's Email:(valid email required)
Parent's Email (1):(valid email required)
Parent's Email (2):(valid email required)
Address:(required)
City:(required)
Zip:(required)
Home Phone:(required)
Cell Phone:(required)
This cell belongs to:(required)
Cell Phone:
This cell belongs to:
Cell Phone:
This cell belongs to:
Parents/Guardian Names:(required)
Student's School:(required)
City:(required)
Does your child have any special needs? (food allergies, physical needs, cognitive or behavioral challenges). Please describe:
Food Allergies:
Other:
Club 56 Suggested Donation (Materials Fee) - $65/student. Fee includes curriculum, Manga Messiah book and 20 lunches. Want to bring your own lunch instead? Subtract $40 from the Materials Fee.
Paid by Check/Cash:
Paid by Credit Card:
Date:
Parents Zone: Parents provide leadership throughout the year as Small Group Leaders (of boys' or girls' groups), Food Support (serving the lunches), and help with special events!
I/we are interested in finding out more about being a small group leader. Call me/us!
I/we can help with lunch preparation, serving and clean-up.
I/we would like to participate in a Bible Study or Parenting group for adults while our student is in club 56
Permission for Pictures: I hereby give permission for any pictures taken of my child to be used only in Nativity Lutheran Church publications.
Child's name:
Parent's name:
Date:

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Club 56 Registration Form

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