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NorthRidge After School Club Registration 2022-23
Please fill out one per child eligible to attend. Contact our Children's Ministry Coordinator, Ashton Kastendick, at 785-285-1606 or
nrfcchildmin@gmail.com
with questions.
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* Indicates required question
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Grade
*
1
2
3
4
5
Parent/Caretaker Name
*
Your answer
Relationship to Child
*
Mother
Father
Other:
Address
*
Your answer
Primary Phone Number
*
Your answer
Other Phone Number
Your answer
Emergency Contact Name (other than listed above)
*
Your answer
Relationship to Child
*
Your answer
Emergency Contact Phone Number
*
Your answer
The above named child has my permission to attend the weekly NorthRidge Church After School Club beginning Tuesday, October 11th, 2022 and be transported to After School Club activities including weekly pick up at school.
*
Yes
Required
I have printed and completed the medical release form found at www.northridgenetwork.org/falls-city.
*
Yes
Required
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