Register Your Child

This year we are blessed to.be partnering with the CBS Food Program, who provides food during the summer to school children (ages 18 and under). From 5:30pm - 6pm l, each might of Summer Kids Club, we will be able to provide a free dinner to each enrolled student and Jr. Volunteer!

We found some errors when you submitted your information. Please see below and fill in the information needed.

Parent Personal Information

Parent First Name:

Parent Last Name:

Address 1:

Address 2:

City:

Country:

State:

Zip:

Email:

Re-Enter Email:

Home Phone Number: (xxx-xxx-xxxx)

Cell Phone Number: (xxx-xxx-xxxx)

Other Phone Number: (xxx-xxx-xxxx)

Emergency Contact

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Phone 1: (xxx-xxx-xxxx)

Emergency Phone 2: (xxx-xxx-xxxx)

Alternate Pickup First Name:

Alternate Pickup Last Name:

Alternate Pickup Phone: (xxx-xxx-xxxx)

Other Information

Home Church (If Applicable):

If your child struggles with social, emotional, or sensory needs, would they benefit from a 1 on 1 "buddy" volunteer? (Yes or No):

For students and Jr Volunteers only (age 18 and under): Will you be joining us for a free dinner from 5:30 - 6pm?: