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DC4K Child Registration Form
The following information will aid DC4K leaders in working with your child.
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Child's Name, Age, Grade & Birth Date:
Your answer
Child's Name, Age, Grade & Birth Date:
Your answer
Child's Name, Age, Grade & Birth Date:
Your answer
Address, City, State & Zip:
Your answer
Home Telephone:
Your answer
Person the child/children lives with:
Your answer
Who has custody?
Choose
Mother
Father
Joint
Guardian
Other
Has child/children attended DC4K before?
Choose
Yes
No
If yes, when & where?
Your answer
Church child attends and city location:
Your answer
Are there any special accommodations we need to be aware of regarding your child/children in order to provide the best program for your child/children?
Choose
Yes
No
If yes, please specify:
Your answer
Does your child/children have any allergies, especially food allergies?
Choose
Yes
No
If yes, please specify:
Your answer
Is there anything else our DC4K leaders should know about your child/children? If yes, please specify:
Your answer
How did you hear about DC4K?
Your answer
Will you be attending the adult DivorceCare program?
Choose
Yes
No
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