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Cherry Log Christian Church (Disciples of Christ)
Godly Play Student Registration & Information Form

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Today’s Date:

Child’s Name:

Date of Birth:

Parent/Grandparent Names:

Address:

Phone Number:  home:    cell:

Email Address:

Alternate emergency contact:

Name:

Relationship:

Cell/best number:

Siblings name(s) and Date of Birth

My child may be released from Godly Play to: (e.g., parents, siblings, grandparents, etc

My child especially enjoys:

Restrictions for my child’s activities, food, or other special concerns are:

We are:

  First time visitors
  Regular visitors
  Members of CLCC

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