Club Ophelia Bear Creek Registration Form     Spring 2022
Please complete this form to register for Club Ophelia Spring 2022. The club will meet in person on Wednesdays from 2/16/22 - 3/30/22 from 3:30-5:00pm at Bear Creek school. Mrs. MaLisa Jordan is the Club Ophelia advisor. Students must be picked up at Bear Creek school after each club session.
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Student First and Last Name
Student Email
Student Home Address
Will the student be able to attend all Club Ophelia sessions for the entire time? (Wednesdays from 3:30-5:00pm: 2/16/22 - 3/30/22)
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Are there any allergies or health issues that you would like the club advisor to be aware of. Please note that snack is provided each week.
Parent / Guardian First and Last Name
Parent / Guardian Email
Parent / Guardian Cell Phone Number
Parent / Guardian emergency contact phone number that can be used during the Club Ophelia time (Wed, 3:30-5:00pm)
Club Ophelia is sponsored and financially supported by the Elizabethtown Area Communities That Care (EACTC). Occasionally EACTC may select photos from Club Ophelia sessions to appear in its publications, on its website, and social media accounts. These photos help create an understanding of the nature of the program, types of activities in which the students participate, and the fun and bonding that occurs during Club Ophelia. The student name is not included with any photos/videos.
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