Club DJ Registration - Countryside Community Church

Club Member's First Name

Club Member's Last Name

Mailing Address

City

Postal Code

Phone

Parent's Name(s)

Allergies

Birth Date (YYYY-MM-DD)

Gender(required)

Boy

Girl

School

Grade

Age

Home Church

Previous Club DJ member?

Yes

I would like to pay my $50/child Registration fee for my child(ren) by:

Cash

Cheque made out to Countryside Community Church (Club DJ registration in the memo)

e-transfer to giving@ccclacrete.com (memo of Club DJ Registration)

I would like to speak to someone about sponsership

Authorization of Parents: