Pinckneyville #204 Kids For Christ Registration Form
Who: Pinckneyville Students Kindergarten through 8th Grade
 (7th and 8th grade Students are welcome to attend and be Helpers!)

What: A non-denominational Bible based after-school program

When: TUESDAYS - April 2nd, 9th, 16th, 23rd & 30th, after school until 5pm
 Please plan to attend your child’s closing program on April 30th at 4:45 - 5:00pm

Why: We teach the truth & hope found in the Bible. This basic foundation of faith will help children their entire lives.

How: Submit 1 registration form below for each child attending. or print and complete the paper registration form and return to the Coordinator.


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Pinckneyville Kids For Christ Registration Form Spring 2024
Child's First Name *
Child's Last Name *
Grade  *
School Teacher *
Parent/Guardian Name *
Street Address, City, state and zip code *
Home Phone Number
Cell Phone Number *
Email Address *
Emergency Contact Full Name (3pm-5pm) *
Emergency Contact Phone Number (3pm-5pm)
 *
Allergies/Special Concerns *
Required
If yes, please explain
I would like to:
Does your child have a bible at home? *
Required
By typing my name below, I give my child permission to attend the after-school Kids For Christ Bible Study. I understand I must confirm all Bible Study plans with his/her school teacher in advance. I assume all risks and hazards incidental to Bible Study participation. *
Required
Parent Signature *
Date Signed *
MM
/
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DISCLAIMER
This program is entirely voluntary and is not affiliated with School District # 204
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