Club DJ Registration Club Member’s First Name(required) Club Member’s Last Name(required) Mailing Address(required) City(required) Postal Code(required) Email(required) Phone(required) Parent’s Name(s)(required) Allergies(required) Birth Date (YYYY-MM-DD)(required) Gender(required) Boy Girl School Grade(required) Select one option Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Age(required) Home Church Previous Club DJ member? Yes No 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: By submitting this form I approve of my child becoming a member of Club DJ. I understand clubs is on wednesdays at 6:30pm and I will endeavor ro pick my child up at 8:00pm (this will enable the leaders to be able to get home in good time) Send
