Crossroads Kids Club Contact Form

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Interested in having your child be a part of an after-school Crossroads Kids Club? If they are currently enrolled at one of our participating schools, please fill out the form below and one of our staff our church ministry partners will be in touch with you.

Parent/Legal Guardian's First and Last Name *

Parent/Legal Guardian's Phone Number *

Parent/Legal Guardian's Email Address

Student's First Name *

Student's Last Name *

Student's Date of Birth *

YYYY

Student's Grade Level *

Student's School *

Submit

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