KIDz University: Session 1: Fall '10 Registration

KIDz U is all about Kids!  K-5th Grade.
Session 1:  Sept. 21, 28, Oct. 5, 12 & 19
Tuesdays 6:30-8:00 PM 

Please complete the following form then press the Submit button. You may register up to three children per registration form.  A copy of your completed registration form will be emailed to the email address you provide below.

We are so excited about having your children attend KzU: Session 1 Fall '10!  Classes for all Children in Kindergarten thru the 5th Grade.

There is a $5 Registration Fee for KzU: Session 1, unless your child is registering for the Photo Booking Class which is $8.

There are a few Tie-Dye T-Shirts left over from KzU: Summer X.  They are $10 while supplies and sizes last.

 

Parent/Gaurdian Information
First Name:
Last Name:
Street Address:
City, State & Zip:
Home Phone:
Work or Cell Phone:
Email:

Child Information
Child 1
Child 1 - First Name:
Child 1 - Last Name:
Child 1 - Grade (Fall 2010):
Child 1 - T-Shirt Size:
Child 1 - Class Selection:
Cupcake Creations - K-5th
I Can FLY! - 3rd-5th
Photo-Booking - 3rd-5th. $8 Reg. Fee & your own digital camera
Child 1 - Allergies/Medical Conditions/Special Needs:
 
Child 2
Child 2 - First Name:
Child 2 - Last Name:
Child 2 - Grade (Fall 2010):
Child 2 - T-Shirt Size:
Child 2 - Class Selection:
Cupcake Creations - K-5th
I Can FLY! - 3rd-5th
Photo-Booking - 3rd-5th. $8 Reg. Fee & your own digital camera
Child 2 - Allergies/Medical Conditions/Special Needs:
 
Child 3
Child 3 - First Name:
Child 3 - Last name:
Child 3 - Grade (Fall 2010):
Child 3 - T-Shirt Size:
Child 3 - Class Selection:
Cupcake Creations - K-5th
I Can FLY! -3rd-5th
Photo-Booking - 3rd-5th. $8 Reg. Fee & your own digital camera
Child 3 - Allergies/Medical Conditions/Special Needs:

 

Emergency Contact Information
Emergency First & Last Name:
Emergency Phone:
Relationship to Child:
  

Additional Information

T-Shirt FOR SALE - KzU: Summer X Tie-Dye
Each T-Shirt is $10.00!**  Please understand that there are limited t-shirts and sizes, but we would love for you to have one of these awesome leftover Tie-Dye KzU T-Shirt.

** Please make checks payable to Pleasant Hill Community Church.

 

Please direct any questions to KIDzU@phcch.org.

 
Special Notes: