Kids & Youth Student Registration PARENT'S NAME* First Last * Email Phone STUDENT'S INFORMATIONNameBirthdateGenderGradeAllergies?Cell Phone NameBirthdateGenderGradeAllergies?Cell Phone NameBirthdateGenderGradeAllergies?Cell Phone Parents: Do we have your permission to contact the student directly?YesNoAnything else we should know?By registering my child(ren) with Chinese Community Church Kids & Youth Ministry, I agree to allow my child(ren)’s photo to be taken while participating in any CCC program. These photos may be used in craft projects, or for promotional and informational purposes including display on CCC website. Please notify Christian Education Board in writing if you object to your child(ren) being photographed. Parent / Guardian Signature Date CAPTCHANameThis field is for validation purposes and should be left unchanged.
