REGISTRATION FORM

(Infant - 6th Grade)

WEDNESDAY NIGHT ALIVE! Fall 2006

Christ the King Lutheran Church, Houston


Name:

 Street:
 City, State, Zip:
Home Phone:
Cell phone(s) parents:                             

                       care giver: 
                       guardian:

Parent(s) E-mail:

(We will communicate with you by e-mail unless you indicate otherwise.)


____ Infant Music Explorers (up to 18 months)              

            5:45 - 6:15

____ Story time (up to 3 years)

          6:00 - 6:15

____ Jr. Music Explorers (18 months - 3 years)

         6:15 - 6:45

____ Godly Play 1 (4 - 6 years)

         6:00 - 6:45

____ Music Explorers (4 - 6 years)

          6:45 - 7:30

____ Godly Play 2 (grades 1 - 6)

         6:00 - 6:45

         Jr. Choristers (grades 1 -3)

         6:45 - 7:30

____ World Explorers (grades 1 - 3)

          6:45 - 7:30

         Choristers (grades 3 - 6)

         6:00 - 6:45

____ Kids Club (grades 3 - 5)

         6:45 - 7:30

 

         Homework Haven

          6:45 - 7:30

 

 Allergies to food or medication:

 In case of an emergency a parent or guardian must be in reach via phone at all times during the programming.
   Name and phone number of doctor:
   Hospital (in emergency):

                                                                             

  Signature:                                                                                Date:

 

Cost per semester: $25 per child      $50 per family            Donation to scholarship fund  

Check      Cash               Date